Methods and devices for providing access into a body cavity

ABSTRACT

Methods and devices are provided for providing surgical access into a body cavity. In one embodiment, a surgical access device is provided that includes a housing coupled to a retractor. The housing can be have one or more movable sealing ports for receiving surgical instruments. Each movable sealing port can include one or more sealing elements therein for sealing the port and/or forming a seal around a surgical instrument disposed therethrough. Each movable sealing port can be rotatable relative to the housing and each sealing element can be rotatable relative to the housing along a predetermined orbital path.

CROSS REFERENCES

The present application is a continuation of U.S. patent applicationSer. No. 16/027,907 (now U.S. Pat. No. 10,470,751) entitled “Methods andDevices for Providing Access into a Body Cavity,” filed on Jul. 5, 2018,which is a divisional of U.S. patent application Ser. No. 15/145,954(now U.S. Pat. No. 10,039,542) entitled “Methods and Devices forProviding Access into a Body Cavity,” filed on May 4, 2016, which is acontinuation of U.S. patent application Ser. No. 14/571,457 (now U.S.Pat. No. 9,351,717) entitled “Methods and Devices for Providing Accessinto a Body Cavity,” filed Dec. 16, 2014, which is a continuation ofU.S. patent application Ser. No. 12/399,625 (now U.S. Pat. No.8,926,506) entitled “Methods and Devices for Providing Access into aBody Cavity,” filed Mar. 6, 2009, which are hereby incorporated byreference in their entireties.

FIELD OF THE INVENTION

The present invention relates to methods and devices for providingsurgical access into a body cavity.

BACKGROUND OF THE INVENTION

Abdominal laparoscopic surgery gained popularity in the late 1980s, whenbenefits of laparoscopic removal of the gallbladder over traditional(open) operation became evident. Reduced postoperative recovery time,markedly decreased post-operative pain and wound infection, and improvedcosmetic outcome are well established benefits of laparoscopic surgery,derived mainly from the ability of laparoscopic surgeons to perform anoperation utilizing smaller incisions of the body cavity wall.

Laparoscopic procedures generally involve insufflation of the abdominalcavity with CO₂ gas to a pressure of around 15 mm Hg. The abdominal wallis pierced and a 5-10 mm in diameter straight tubular cannula or trocarsleeve is then inserted into the abdominal cavity. A laparoscopictelescope connected to an operating room monitor is used to visualizethe operative field, and is placed through a the trocar sleeve.Laparoscopic instruments (graspers, dissectors, scissors, retractors,etc.) are placed through two or more additional trocar sleeves for themanipulations by the surgeon and surgical assistant(s).

Recently, so-called “mini-laparoscopy” has been introduced utilizing 2-3mm diameter straight trocar sleeves and laparoscopic instruments. Whensuccessful, mini-laparoscopy allows further reduction of abdominal walltrauma and improved cosmesis. Instruments used for mini-laparoscopicprocedures are, however, generally more expensive and fragile. Becauseof their performance limitations, due to their smaller diameter (weaksuction-irrigation system, poor durability, decreased video quality),mini-laparoscopic instruments can generally be used only on selectedpatients with favorable anatomy (thin cavity wall, few adhesions,minimal inflammation, etc.). These patients represent a small percentageof patients requiring laparoscopic procedures. In addition, smaller 2-3mm incisions may still cause undesirable cosmetic outcomes and woundcomplications (bleeding, infection, pain, keloid formation, etc.).

Since the benefits of smaller and fewer body cavity incisions areproven, it would be desirable to perform an operation utilizing only asingle incision. An umbilicus is well-hidden and the thinnest and leastvascularized area of the abdominal wall. The umbilicus is generally apreferred choice of abdominal cavity entry in laparoscopic procedures.An umbilical incision can be easily enlarged (in order to eviscerate alarger specimen) without significantly compromising cosmesis and withoutincreasing the chances of wound complications. One drawback with entrythrough the umbilicus, however, is that the placement of two or morestandard (straight) cannulas and laparoscopic instruments in theumbilicus, next to each other, creates a so-called “chopstick” effect,which describes interference between the surgeon's hands, between thesurgeon's hands and the instruments, and between the instruments. Thisinterference greatly reduces the surgeon's ability to perform adescribed procedure.

Thus, there is a need for instruments and trocar systems which allowlaparoscopic procedures to be performed entirely through the umbilicusor a surgical port located elsewhere while at the same time reducing oreliminating the “chopstick effect.”

SUMMARY OF THE INVENTION

The present invention generally provides methods and devices forproviding surgical access into a body cavity. In one embodiment, asurgical access device is provided that includes a housing having aworking channel extending therethrough, and a base coupled to thehousing and having first and second sealing elements. The base isconfigured to rotate relative to the housing, and the first and secondsealing elements are each configured to receive an instrument insertedtherethrough and into the working channel. Each of the first and secondsealing elements are movable independent of another of the first andsecond sealing elements in a predetermined orbital path.

The first and second sealing elements and the predetermined orbitalpaths in which they are movable can have any number of variations. Forexample, each of the first and second sealing elements can be laterallymovable in a predetermined orbital path. For another example, the firstsealing element with a surgical instrument held in a substantially fixedposition therein can be configured to move in a predetermined orbitalpath in response to movement of the second sealing element in apredetermined orbital path. For yet another example, the predeterminedorbital paths of the first and second sealing elements can each have acentral axis that is offset from a central axis of the base. For stillanother example, each of the first and second sealing elements can bedisposed within a support that is rotatably disposed within the base,each sealing element being eccentric relative to its respective support.In some embodiments, each of the first and second sealing elements caneach be configured to provide a fluid seal with no instrument insertedtherethrough.

The device can vary in any other number of ways. For example, the basecan include first and second cut-outs formed therein, and perimeters ofthe first and second cut-outs can respectively define the predeterminedorbital paths of the first and second sealing elements. In someembodiments, the device can include a side access port formed in aproximal retractor base configured to be coupled to the housing andconfigured to receive an instrument inserted therethrough. The sideaccess port can extend in a plane that is offset from a plane containingthe base. For yet another example, the device can include a retractorfixedly or rotatably coupled to the housing. The retractor can have aretractor shield disposed therein.

In some embodiments the device can include at least one fixed sealingelement fixedly disposed within the base and configured to remain in afixed position relative to the base. The first and second sealingelements and the at least one fixed sealing element can be positionedradially around a central axis of the base. The at least one fixedsealing element can be disposed in a plane offset from and parallel to aplane containing the first and second sealing elements. The device caninclude first and second fixed sealing elements, the first fixed sealingelement being positioned below a plane containing the first and secondsealing elements and the second fixed sealing element being positionedabove the plane containing the first and second sealing elements.

In yet another embodiment, a surgical access device is provided thatincludes a housing defining a working channel. The housing has a base, asupport rotatably disposed in the base, and a sealing element disposedin the support at a location offset from a central rotational axis ofthe support. The sealing element is configured to receive a surgicalinstrument inserted therethrough and into the working channel. In someembodiments, the housing can have a second support rotatably disposed inthe base and a second sealing element disposed at a location offset froma central rotational axis of the second support. The second sealingelement can be configured to receive a surgical instrument insertedtherethrough and into the working channel. The central rotational axisof the second support can be offset from the central rotational axis ofthe first support. The sealing element with a surgical instrument heldin a substantially fixed position therein can be configured to move in apredetermined orbital path in response to movement of the second sealingelement in a predetermined orbital path. The device can have any numberof variations. For example, the central rotational axis of the supportis offset from a central axis of the base. For another example, the basehas at least one fixed sealing element that is configured to remain in afixed position relative to the base and to move with the base relativeto the housing.

In yet another embodiment, a surgical access device is provided thatincludes a housing having a base rotatably coupled thereto. The base hasa plurality of sealing elements including at least one movable sealingelement configured to form a seal around an instrument insertedtherethrough and being rotatable relative to the base independent of theother sealing elements. Rotation of the at least one movable sealingelement relative to the base is effective to change a distance of the atleast one movable sealing element from a center-point of the base. Insome embodiments, the base can have first and second movable sealingelements. The device can have any number of variations. For example, thebase can be circular-shaped and configured to rotate around thecenter-point of the base. For another example, the at least one movablesealing element can be rotatable in a plane of the base. In someembodiments, the device can include a flexible retractor coupled to thehousing. A side access port can be formed in a proximal retractor baseof the retractor and configured to receive a retractor insertedtherethrough. The base can be configured to rotate relative to the sideaccess port. For another example, the housing can define a workingchannel extending therethrough between a proximal end of the housing anda distal end of the housing. The base can be located at a proximal endof the housing such that instruments inserted through the sealingelements extend through the working channel. The at least one movablesealing elements can be disposed within a support that is rotatablydisposed within a predefined shape formed in the base, the at least onemovable sealing element being eccentric relative to its support. Thecenter-point of the base can be spaced apart from the predefined shapes.

In another aspect, a method of providing access through tissue to a bodycavity is provided. The method includes positioning a surgical accessdevice within an opening formed through tissue such that the surgicalaccess device forms a working channel extending through the tissue andinto a body cavity, inserting a first surgical instrument through afirst sealing element in the surgical access device and through theworking channel of the surgical access device to position a distal endof the first surgical instrument within the body cavity, and moving thefirst surgical instrument to cause the first sealing element to movealong an orbital path from a first position, in which the first sealingelement is located a first distance from a center-point of the surgicalaccess device, to a second position, in which the first sealing elementis located a second distance from the center-point of the surgicalaccess device that is different from the first distance. The method canhave any number of variations. For example, moving the first surgicalinstrument can cause rotation of a base of the surgical access devicethat is coupled to the housing. The rotation of the base can cause asecond sealing element in the surgical access device having a secondsurgical instrument inserted therethrough to move along an orbital pathfrom a third position, in which the second sealing element is located athird distance from the center-point of the surgical access device, to afourth position, in which the second sealing element is located a fourthdistance from the center-point of the surgical access device that isdifferent from the third distance. For another example, the workingchannel can extend through a housing of the surgical access device, andmoving the first surgical instrument can cause a base of the surgicalaccess device that is coupled to the housing to rotate relative to thehousing.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention will be more fully understood from the following detaileddescription taken in conjunction with the accompanying drawings, inwhich:

FIG. 1 is a perspective view of one embodiment of a surgical accessdevice having first and second fixed sealing ports and first and secondmovable sealing ports extending therethrough;

FIG. 2 is a top view of the device of FIG. 1;

FIG. 3 is a cross-sectional view of the device of FIG. 1;

FIG. 4 is another cross-sectional view of the device of FIG. 1;

FIG. 5 is a partial cross-sectional, exploded view of the device of FIG.1;

FIG. 6 is an exploded view of a seal base and sealing ports of thedevice of FIG. 1;

FIG. 7A is a top view of the seal base of the device of FIG. 1 withoutsealing ports extending through the seal base;

FIG. 7B is a bottom view of the seal base of the device of FIG. 1without sealing ports extending through the seal base;

FIG. 8 is a partial, exploded view of a fixed sealing port of the deviceof FIG. 1;

FIG. 9 is an exploded view of another fixed sealing port of the deviceof FIG. 1 and a partial perspective view of the seal base in which thefixed sealing port can be disposed;

FIG. 10 is an exploded view of a movable sealing port of the device ofFIG. 1;

FIG. 11 is a top view of the device of FIG. 1 with one of the movablesealing ports rotated relative to the seal base, a housing, and aretractor of the device;

FIG. 12 is a top view of the device of FIG. 1 with the seal base rotatedrelative to the housing and the retractor, and one of the movablesealing ports rotated relative to the seal base, the housing, and theretractor;

FIG. 13 is a top view of the device of FIG. 1 with the seal base rotatedrelative to the housing and the retractor, and each of the movablesealing ports rotated relative to the seal base, the housing, theretractor, and each other;

FIG. 14 is a perspective view of one embodiment of a seal assembly;

FIG. 15 is a partial cross-sectional view of one embodiment of aresilient seal assembly;

FIG. 16 is a partial cross-sectional view of another embodiment of aresilient seal assembly;

FIG. 17 is a partial cross-sectional view of one embodiment of aresilient seal assembly having a hollow interior;

FIG. 18 is a partial cross-sectional, perspective, exploded view of thedevice of FIG. 1 with the retractor positioned in tissue;

FIG. 19 is a partial cross-sectional, perspective, exploded view of thedevice of FIG. 18 with a spring assembly positioned in the retractor;

FIG. 20 is a partial cross-sectional, perspective, view of the device ofFIG. 19 positioned in the tissue;

FIG. 21A is a perspective view of first and second surgical instrumentseach inserted through a movable sealing port in the device of FIG. 20;

FIG. 21B is a perspective view of first and second surgical instrumentseach inserted through a fixed sealing port of another embodiment of asurgical access device;

FIG. 22A is a partial cross-sectional, perspective view of the first andsecond surgical instruments of FIG. 21A with a proximal portion of thefirst surgical instrument moved closer to a proximal portion of thesecond surgical instrument and a distal portion of the first surgicalinstrument moved away from a distal portion of the second surgicalinstrument;

FIG. 22B is a partial cross-sectional, perspective view of the first andsecond surgical instruments of FIG. 21B with a proximal portion of thefirst surgical instrument moved closer to a proximal portion of thesecond surgical instrument and a distal portion of the first surgicalinstrument moved away from a distal portion of the second surgicalinstrument;

FIG. 23A is a perspective view of the first and second surgicalinstruments of FIG. 22A with the proximal portion of the first surgicalinstrument moved vertically and horizontally relative to the proximalportion of the second surgical instrument and the distal portion of thefirst surgical instrument moved vertically and horizontally relative tothe distal portion of the second surgical instrument;

FIG. 23B is a perspective view of the first and second surgicalinstruments of FIG. 22B with the proximal portion of the first surgicalinstrument moved vertically and horizontally relative to the proximalportion of the second surgical instrument and the distal portion of thefirst surgical instrument moved vertically and horizontally relative tothe distal portion of the second surgical instrument;

FIG. 24A is a side view of the first and second surgical instrumentsinserted through the device of FIG. 23A;

FIG. 24B is a side view of the first and second surgical instrumentsinserted through the device of FIG. 23B;

FIG. 25A is another side view of the first and second surgicalinstruments inserted through the device of FIG. 23A;

FIG. 25B is another side view of the first and second surgicalinstruments inserted through the device of FIG. 23B;

FIG. 26A is a bottom view of the first and second surgical instrumentsinserted through the device of FIG. 23A;

FIG. 26B is a bottom view of the first and second surgical instrumentsinserted through the device of FIG. 23B;

FIG. 27A is a top view of the first and second surgical instrumentsinserted through the device of FIG. 23A;

FIG. 27B is a top view of the first and second surgical instrumentsinserted through the device of FIG. 23B;

FIG. 28 is a partial cross-sectional, perspective, exploded view of thedevice of FIG. 1 with the retractor deformed in tissue;

FIG. 29 is a partial cross-sectional, side view of the device of FIG. 28with a waste disposal bag passing through a working channel of theretractor positioned in tissue;

FIG. 30 is a partial cut-away, exploded view of another embodiment of asurgical access device;

FIG. 31 is an exploded view of a seal base of the device of FIG. 30;

FIG. 32 is an exploded view of the device of FIG. 30 with a springassembly positioned in a retractor;

FIG. 33 is a partial cross-sectional view of the assembled device ofFIG. 30;

FIG. 34 is an exploded view of yet another embodiment of a surgicalaccess device;

FIG. 35 is a cross-sectional view of another embodiment of a surgicalaccess device;

FIG. 36 is a partial cross-sectional view of yet another embodiment of asurgical access device;

FIG. 37 is a cross-sectional view of another embodiment of a surgicalaccess device;

FIG. 38 is a cross-sectional view of yet another embodiment of asurgical access device including one embodiment of a safety shield;

FIG. 39 is a perspective view of the safety shield of FIG. 38;

FIG. 40 is an exploded view of the safety shield of FIG. 38;

FIG. 41 is a cross-sectional side view of a second embodiment of asafety shield;

FIG. 42 is a cross-sectional top view of the safety shield of FIG. 41;

FIG. 43 is a perspective view of a third embodiment of a safety shield;

FIG. 44 is a cross-sectional side view of the safety shield of FIG. 43;

FIG. 45 is a cross-sectional top view of the safety shield of FIG. 43;

FIG. 46 is a cross-sectional view of another embodiment of a surgicalaccess device including one embodiment of a side access port with asurgical instrument inserted therethrough;

FIG. 47 is a cross-sectional view of the side access port of FIG. 46;

FIG. 48 is a cross-sectional view of yet another embodiment of asurgical access device including another embodiment of a side accessport with a surgical instrument inserted therethrough;

FIG. 49 is a partial cross-sectional view of the side access port andthe device of FIG. 48;

FIG. 50 is a cross-sectional view of the device of FIG. 46 with thesurgical instrument inserted through the side access port in a minimizedinsertion position; and

FIG. 51 is a cross-sectional view of the device of FIG. 46 with thesurgical instrument inserted through the side access port in a maximizedinsertion position.

DETAILED DESCRIPTION OF THE INVENTION

Certain exemplary embodiments will now be described to provide anoverall understanding of the principles of the structure, function,manufacture, and use of the devices and methods disclosed herein. One ormore examples of these embodiments are illustrated in the accompanyingdrawings. Those skilled in the art will understand that the devices andmethods specifically described herein and illustrated in theaccompanying drawings are non-limiting exemplary embodiments and thatthe scope of the present invention is defined solely by the claims. Thefeatures illustrated or described in connection with one exemplaryembodiment may be combined with the features of other embodiments. Suchmodifications and variations are intended to be included within thescope of the present invention.

Various exemplary methods and devices are provided for providingsurgical access into a body cavity. In general, the methods and devicesallow multiple surgical instruments to be inserted through independentaccess ports in a single surgical access device and into a body cavity.The instruments can be collectively rotatable about a central axis ofthe device, and they can be independently movable with respect to oneanother, thus allowing for ease of manipulation within a patient's body.In one embodiment, a surgical access device includes a housing havingone or more movable access ports or movable sealing ports for receivingsurgical instruments. Each movable sealing port can include one or moresealing elements therein for sealing the port and/or forming a sealaround a surgical instrument disposed therethrough. The movable sealingports can each be rotatable relative to the housing and the sealingelements can move around a predetermined orbital path, thereby allowinginstruments inserted therethrough and into the body cavity to beoptimally positioned. This can help avoid the “chopstick effect” andprovide increased working space for instruments within the body cavity.The movable sealing ports can also be configured such that movement of afirst surgical instrument inserted through a first movable sealing portcan cause movement of a second movable sealing port to allow a secondsurgical instrument inserted through the second movable sealing port toremain in a fixed position, which can help optimally position theinstruments with respect to each other.

The various surgical access devices can also include a wound protector,cannula, ring retractor, or other member for forming a pathway throughtissue (hereinafter generally referred to as a retractor). The retractorcan extend from the housing and it can be configured to be positionedwithin an opening in a patient's body, such as the umbilicus. Thesealing ports can each define working channels extending through thehousing and aligned with the retractor. Any and all of the surgicalaccess devices described herein can also include various other features,such as one or more ventilation ports to allow evacuation of smokeduring procedures that utilize cautery, and/or one or more insufflationports through which the surgeon can insufflate the abdomen to causepneumoperitenium, as described by way of non-limiting example in U.S.Patent Application No. 2006/0247673 entitled “Multi-port LaparoscopicAccess Device” filed Nov. 2, 2006, which is hereby incorporated byreference in its entirety. The insufflation port can be located anywhereon the device, can have any size, and can accept a leur lock or aneedle, as will be appreciated by those skilled in the art.

As discussed further below, any and all embodiments of a surgical accessdevice can also include one or more safety shields positioned through,in, and around any of the components and/or tissue to protect thecomponents against puncture or tear by surgical instruments beinginserted through the device. In addition, any and all embodiments of asurgical access device can include engagement and release mechanismsthat allow certain components of the surgical access device to beremovable as needed.

In use, and as also further discussed below, the surgical access devicesdisclosed herein can be used to provide access to a patient's bodycavity. The retractor can be positionable within an opening in apatient's body such that a distal portion of the retractor extends intoa patient's body cavity and a proximal portion configured to couple to ahousing is positioned adjacent to the patient's skin on an exterior ofthe patient's body. A lumen in the retractor can form a pathway throughthe opening in a patient's body so that surgical instruments can beinserted from outside the body to an interior body cavity. Theelasticity of the skin of the patient can assist in the retention of theretractor in the body opening or incision made in the body. Theretractor can be placed in any opening within a patient's body, whethera natural orifice or an opening made by an incision. In one embodiment,the retractor can be substantially flexible so that it can easily bemaneuvered into and within tissue as needed. In other embodiments, theretractor can be substantially rigid or substantially semi-rigid. Theretractor can be formed of any suitable material known in the art, e.g.,silicone, urethane, thermoplastic elastomer, and rubber.

Typically, during surgical procedures in a body cavity, such as theabdomen, insufflation is provided through the surgical access device toexpand the body cavity to facilitate the surgical procedure. Thus, inorder to maintain insufflation within the body cavity, most surgicalaccess devices include at least one seal disposed therein to prevent airand/or gas from escaping when surgical instruments are insertedtherethrough. Various sealing elements are known in the art, buttypically the surgical access device can include at least one instrumentseal that forms a seal around an instrument disposed therethrough, butotherwise does not form a seal when no instrument is disposedtherethrough; at least one channel seal or zero-closure seal that sealsthe working channel created by the sealing port when no instrument isdisposed therethrough; or a combination instrument seal and channel sealthat is effective to both form a seal around an instrument disposedtherethrough and to form a seal in the working channel when noinstrument is disposed therethrough. A person skilled in the art willappreciate that various seals known in the art can be used including,e.g., duckbill seals, cone seals, flapper valves, gel seals, diaphragmseals, lip seals, iris seals, etc. A person skilled in the art will alsoappreciate that any combination of seals can be included in any of theembodiments described herein, whether or not the seal combinations arespecifically discussed in the corresponding description of a particularembodiment.

In an exemplary embodiment, shown in FIGS. 1-6, a surgical access device10 includes at least one fixed sealing port and at least one movablesealing port. The surgical access device 10 can have a housing 16removably coupled on one end to a seal base 26 that supports the fixedand movable sealing ports on another end and to a retractor 18configured to distally extend from the housing 16. While any number offixed and movable sealing ports can be formed in the seal base 26, inthis illustrated embodiment, first and second fixed sealing ports 12 a,12 b and first and second movable sealing ports 14 a, 14 b extendthrough the seal base 26. The base 26 can be movable with respect to thehousing 16 and the retractor 18, and the first and second movablesealing ports 14 a, 14 b can be movable with respect to the base 26, thehousing 16, the retractor 18, and each other, as will be discussed inmore detail below. Such a configuration can help prevent interferencebetween surgical instruments inserted through various ones of thesealing ports 12 a, 12 b, 14 a, 14 b, and can facilitate instrumentpositioning in a body cavity to which the device 10 provides access.

The device 10 can also include an insufflation port 28 supported by thebase 26, although a person skilled in the art will appreciate that theinsufflation port 28 can be located in the housing 16 or in otherlocations. A person skilled in the art will also appreciate that theinsufflation port 28 can have a variety of configurations. Generally,the insufflation port 28 can be configured to pass an insufflation fluidthrough an insufflation orifice 28 a of the insufflation port 28 intoand/or out of a body cavity to which the device 10 provides access.

A proximal portion 30 of the surgical access device 10 can, as shown,include the seal base 26, the housing 16 in the form of a lock ringconfigured to releasably attach the base 26 to the retractor 18, and aspring assembly 32 configured to be disposed between the seal base 26and the lock ring 30 to form a seat and seal between the base 26 and adistal portion of the device 10, e.g., the retractor 18. The retractor18, the seal base 26, the housing 30, and the spring assembly 32 caneach have various sizes, shapes, and configurations, as discussedfurther below.

As noted above, the retractor 18 can extend from the housing 16, and itcan be configured to be positioned in an opening formed in tissue. Theretractor 18 can, as shown in this exemplary embodiment, be asubstantially flexible member having a proximal flange 46 and a distalflange 40 with an inner elongate portion 42 extending therebetween. Theinner elongate portion 42 can have a diameter less than a diameter ofthe proximal and distal flanges 46, 40, which can have the same diameteror different diameters from one another. The proximal flange 46 can beconfigured to be seated within a proximal retractor base 38 in aproximal portion of the retractor 18 and optionally attached theretousing an adhesive, sealant, complementary threads, or any otherattachment mechanism, as will be appreciated by a person skilled in theart. A proximal o-ring 48 can be optionally positioned within theproximal flange 46 to help provide structural support to the retractor18 within the proximal retractor base 38. A distal o-ring 44 canoptionally be positioned within the distal flange 40 to providestructural support to the retractor 18 within a patient's body. Theproximal and distal o-rings 48, 44 can be substantially flexible orsubstantially rigid as needed, same or different from one another, foruse in a particular application.

The housing 16 can, as illustrated, be a substantially rigid cylindricalor circular member and can have a proximal circumferential sidewall witha diameter less than a diameter of a distal circumferential sidewall ofthe housing 16. A middle connecting circumferential sidewall 50 canextend between the proximal and distal sidewalls at an angle radiallyoutward from the proximal and distal sidewalls. The middle sidewall 50can have a size and shape corresponding to a complementary lip 52 formedon and extending radially outward from the seal base 26 such that themiddle sidewall 50 can be configured to engage the lip 52 and movablycouple the seal base 26 to the housing 16 and the retractor 18 when thehousing 16 is attached to the retractor 18.

While any engagement and release mechanism known in the art can be usedto releasably mate the housing 16 and the retractor 18 together, asillustrated in the embodiment shown in FIGS. 1-5, the device 10 caninclude an engagement and release mechanism in the form of a bayonetlatch mechanism. At least one bayonet foot or pin, e.g., four radiallyarranged bayonet feet or pins 34 spaced equidistantly or any otherdistance apart, can extend any length from an inner circumference of thehousing 16, e.g., from the distal sidewall, and they can be configuredto engage corresponding slots 36 formed in an outer surface of theproximal retractor base 38. The bayonet pins 34 on the housing 16 can belowered into the slots 36 in the proximal retractor base 38. The housing16 can then be rotated in a first direction, e.g., a clockwisedirection, relative to the retractor 18, thereby causing the bayonetpins 34 to travel laterally within the slots 36 to a position in whichthe pins 34 abut terminal ends 36 a of the slots 36, thereby locking thehousing 16 to the retractor 18. One or more of the slots 36 can angleproximally or distally (not shown) at their respective terminal ends 36a such that the bayonet pins 34 can proximally or distally slide andsnap into the terminal ends 36 a to help ensure that the bayonet pins 34fully slide through the slots 36 to lock the housing 16 to the retractor18. The housing 16 can optionally include surface features 16 a, e.g.,ridges, bumps, textured surface, etc., to help facilitate gripping andturning of the housing 16. If disengagement of the housing 16 and theretractor 18 is desired, e.g., to replace the seal base 26 with anotherseal base having a different number or different sizes of sealing portsor to replace the retractor 18, the housing 16 can be rotated in thesecond, opposite direction such that the bayonet pins 34 are free to bewithdrawn from the slots 36.

With the housing 16 locked to the proximal retractor base 38, the sealbase 26 can be rotated in the first direction and in a second oppositedirection, e.g., a counter clockwise direction, to rotate the seal base26 relative to the housing 16 as well as to the retractor 18. While thebase 26 can be configured to be rotatable relative to the housing 16 andthe retractor 18 in only one of the first and second directions, thebase 26 as illustrated is rotatable in both the first and seconddirections, which can help more effectively position surgicalinstruments inserted through the seal base 26 with respect to eachother.

As indicated above, the spring assembly 32 can be positioned between theseal base 26 and the retractor 18. More particularly, the springassembly 32 can be coupled between a distal surface of the base's lip 52and an interior ledge 54 of the proximal retractor base 38. The interiorledge 54 can continuously run circumferentially around the proximalretractor base 38 as shown, or the interior ledge 54 can run around oneor more discrete portions of the proximal retractor base 38.

Although the spring assembly 32 can have a variety of sizes, shapes, andconfigurations as mentioned above, the spring assembly 32 can, as shown,include distal and proximal spring retaining rings 32 a, 32 c with aseal spring 32 b positioned therebetween. To help provide resiliency tothe spring assembly 32, the seal spring 32 b can be a substantiallyc-shaped ring having a cut-out 62 formed through one section of itscircumference and can have a wavy configuration with alternatingproximally extending portions 56 a and distally extending portions 56 b.The distal and proximal spring retaining rings 32 a, 32 c can each be asubstantially circular ring and can each have a planar configuration butcan be configured to engage both the proximally extending portions 56 aand the distally extending portions 56 b of the seal spring 32 b. Fornon-limiting example, the distal and proximal spring retaining rings 32a, 32 c can include respective hemispherical dimples 58, 60. The distalspring retaining ring's dimples 58 can be proximally facing andconfigured to engage and be positioned under the proximally extendingportions 56 a of the seal spring 32 b, and the proximal spring retainingring's dimples 60 can be distally facing and configured to engage and bepositioned under the distally extending portions 56 b of the seal spring32 b. In the illustrated embodiment, the seal spring 32 b includes twoproximally extending portions 56 a and two distally extending portions56 b with the distal and proximal spring retaining rings 32 a, 32 c eachincluding two dimples 58, 60 corresponding to their respective wavyportions of the seal spring 32 b, but a person skilled in the art willappreciate that the seal spring 32 b can have any number of proximallyand distally extending portions with the distal and proximal springretaining rings 32 a, 32 c having any number of corresponding dimples58, 60 or other stabilizing mechanism. A person skilled in the art willalso appreciate that the dimples 58, 60 can be same or different fromany of the other simples 58, 60 and that they can each have any size andshape, e.g., hemispherical, a spherical segment, conical, box-shaped,etc. The generally circular shapes of the seal assembly's components cangenerally conform the shape of the seal assembly 32 to the curved shapesof the seal base 26 and the retractor 18 to which the seal assembly 32can be mated. While the seal assembly 32 can be configured to preventvertical movement, e.g., proximal and/or distal movement along thecentral axis of the working channel, of the base 26 with respect to theretractor 18, the dimples 58, 60 can allow the seal assembly 32 toprovide for vertical movement of the base 26 relative to the retractor18, which can help provide for smoother rotation of the base 26 withrespect to the housing 16. The distal and proximal spring retainingrings 32 a, 32 c can be configured to rotate relative to one another, asshown in this embodiment, which can also help provide for smoothrotation of the base 26 relative to the housing 16. The distal andproximal spring retaining rings 32 a, 32 c and the seal spring 32 b caneach be configured to rotate relative to the other elements of the sealassembly 32, as illustrated.

FIG. 14 illustrates an alternate embodiment of a seal assembly 64 thatincludes distal and proximal spring retaining rings 64 a, 64 c with aseal spring 64 b positioned therebetween. The alternate seal assembly 64is similar to the seal assembly 32 described above except that thealternate seal assembly 64 includes a locking mechanism configured tomaintain the distal and proximal spring retaining rings 64 a, 64 c ofthe seal assembly 64 in a fixed radial position with respect to oneanother. The distal and proximal spring retaining rings 64 a, 64 c canbe nevertheless be configured to be vertically movable with respect toone another, such as by including respective dimples 70 (only the distalspring retaining ring's dimples 70 are visible in FIG. 14) that engagewavy portions of the seal spring 64 b, similar to that discussed above.

The seal assembly's locking mechanism can have a variety ofconfigurations, and in this embodiment includes at least one tab 66.Although three radially arranged tabs 66 are spaced equidistantly apartaround an inner circumference of the illustrated seal assembly 64, aperson skilled in the art will appreciate that the seal assembly 64 caninclude any number of tabs 66 and that the tabs 64 can be arranged inany way. The tabs 66 include c-shaped clamps integrally formed with theproximal spring retaining ring 64 c, although the tabs 66 can have anysize, shape, and configuration and can be integrally formed with eitheror both of the spring retaining rings 64 a, 64 c or can be anindependent element configured to couple to the spring retaining rings64 a, 64 c. The tabs 66 extend from an inner circumference of theproximal spring retaining ring 64 c, through an inner lumen 68 of theseal assembly 64, and to the distal spring retaining ring 64 a.Positioning the locking mechanism substantially within the sealassembly's inner lumen 68 can help prevent the locking mechanism fromimpeding with the seal assembly's fit and rotation within the housingand the retractor to which the seal assembly 64 is mated. Each of thetabs 66 can mate to the distal spring retaining ring 64 a with a notch66 a formed in a distal portion of the tab 66 that is configured to seatthe distal spring retaining ring 64 a therein. Although the tabs 66 areshown as identical to one another, each tab 66 can be the same ordifferent from any other of the tabs 66. A seal assembly can include oneor more types of locking mechanisms.

While a surgical access device can include a seal assembly havingmultiple components, e.g., the seal assembly 32 of FIG. 5 and the sealassembly 64 of FIG. 14, in some embodiments a surgical access device caninclude a singular seal assembly configured to form a seat and sealbetween a seal base and a distal portion of a surgical access device towhich the seal base is removably attached. FIG. 15 illustrates oneembodiment of a singular seal member 72 in the form of a circular ringcomposed of a resilient foam material. Any resilient foam material canbe used based on design choice for a particular spring rate, e.g.,foamed polypropylene or polyethylene, sanoprene, and isoprene. The sealmember 72 has a square cross-sectional shape, although the seal membercan have any cross-sectional shape. For non-limiting example, as shownin FIG. 16, a singular seal member 74 composed of a resilient foammaterial and having a circular ring shape has a z-shaped cross-sectionalshape. Although the singular seal members 72, 74 have solidcross-sections, in some embodiments, a singular seal member can have ahollow or partially hollow interior. FIG. 17 illustrates one embodimentof a hollow singular seal member 76 having a circular ring shape and asquare cross-sectional shape with a square-shaped hollow interior.

The seal base 26 can have a variety of sizes, shapes, andconfigurations, as can the fixed and movable sealing ports 12 a, 12 b,14 a, 14 b seated therein. As shown in FIG. 6, the seal base 26 caninclude proximal and distal base portions 26 a, 26 b configured to matetogether with the first and second fixed sealing ports 12 a, 12 b andthe first and second movable sealing ports 14 a, 14 b capturedtherebetween. The proximal base portion 26 a can have a circularproximal surface 78 and a circumferential wall 82 extending distallyfrom the proximal surface 78. The circumferential wall 82 can optionallyinclude one or more cut-out portions 82 a formed therein that areconfigured to help angle surgical instruments inserted through the base26, as discussed further below. While any attachment or mating mechanismcan be used to fixedly or removably mate the proximal and distal baseportions 26 a, 26 b together, in the illustrated embodiment, an innercircumference of the proximal base portion 26 a, e.g., an inner surfaceof the circumferential wall 82, can be configured to mate with an outersurface of a lip 84 proximally extending from the lip 52 formed on andextending from the distal base portion 26 b. The proximal and distalbase portions 26 a, 26 b can be fixedly attached together using anattachment mechanism, e.g., adhesive, sealant, etc., although asmentioned above, the proximal and distal base portions 26 a, 26 b can beremovably attached together using an attachment mechanism, such ascomplementary threads. The proximal and distal base portions 26 a, 26 bcan also or alternatively be held together by the housing 16.

As shown in FIGS. 7A and 7B, first, second, third, and fourth portcut-outs or openings 80 a, 80 b, 80 c, 80 d can be formed through theseal base 26, e.g., through both the proximal and distal base portions26 a, 26 b, for respectively receiving the sealing ports 12 a, 12 b, 14a, 14 b. The seal base 26 can also have an insufflation port cut-out oropening 80 e formed therethrough for seating the insufflation port 28. Aperson skilled in the art will appreciate that there can be any numberof port openings formed in the seal base 26 that can be arranged in anyway in the base 26. As shown in the illustrated embodiment, the portopenings 80 a, 80 b, 80 c, 80 d, and hence also the sealing ports 12 a,12 b, 14 a, 14 b, can be radially arranged around a central axis orcenter-point 94 of the seal base 26 with the fixed sealing ports 12 a,12 b and the movable sealing ports 14 a, 14 b alternating around thebase center-point 94.

The port openings 80 a, 80 b, 80 c, 80 d can also have any combinationof sizes and shapes. As shown, the port openings 80 a, 80 b, 80 c, 80 dcan each have a shape corresponding to a shape of the sealing port 12 a,12 b, 14 a, 14 b, 28 seated therein, which in this illustratedembodiment is substantially circular for each of the openings 80 a, 80b, 80 c, 80 d. The first port opening 80 a for seating the first fixedsealing port 12 a can have a first diameter D1 that is larger than asecond diameter D2 of the second port opening 80 b for seating thesecond fixed sealing port 12 b, and the third and fourth port openings80 c, 80 d for respectively seating the movable sealing ports 14 a, 14 bcan each have a third diameter D3 that is larger than both the first andsecond diameters D1, D2. The insufflation port opening 80 e can have anydiameter D4. The third diameter D3 of the third and fourth port openings80 c, 80 d can define a diameter of an orbital path of first and secondmovable sealing elements, as discussed further below. For non-limitingexample, the base 26 can have a diameter D5 of about 60 mm, the firstdiameter D1 can be about 15 mm, the second diameter D2 can be about 9mm, the third diameter D3 can be about 25 mm, and the insufflationdiameter D4 can be about 2 mm.

In some embodiments, the proximal base surface of the seal base can besubstantially flat with port openings being formed in a same plane witheach other, either co-planar parallel to the proximal base surface orrecessed in the seal base. In other embodiments, such as the oneillustrated in FIGS. 1-6, the proximal base surface 78 can be non-planarwith at least one recessed portion extending in a plane distallydisplaced from and parallel to a plane of the proximal base surface 78and/or at least one raised portion proximally displaced from andparallel to a plane of the proximal base surface 78. The base 26 canalso have port openings formed in the plane of the proximal base surface78, such as the third and fourth port openings 80 c, 80 d seating thethird and fourth movable sealing ports 14 a, 14 b. The seal base's oneor more recessed portions and one or more raised portions can helpcompensate for sealing elements of different lengths to help preventdistal seal element openings of each of the sealing elements fromcontacting an interior of the retractor 18, as discussed below, at leastwhen the surgical access device 10 is in a default position, e.g., asillustrated in FIGS. 1-4, where the device 10 is not positioned intissue and has no surgical instruments inserted therethrough.

In this illustrated embodiment, the seal base 26 has one raised orproximally extending housing 96 in which the first port opening 80 a isformed. The raised housing 96 can have any height, same or differentfrom any other raised housings, configured to help provide clearanceroom for the first fixed sealing element 20 seated in the first portopening 80 a positioned above the proximal base surface 78 to helpprevent the first fixed sealing element from contacting the retractor18, as discussed below, at least when the surgical access device 10 isin the default position. The raised housing 96 can be rigid, as shown,or it can be flexible to allow the raised housing 96 to move vertically,laterally, and angularly relative to the seal base 26.

The illustrated seal base 26 also has one recessed portion 98 in whichthe second port opening 80 b is formed. The recessed portion 98 can berecessed any depth below the proximal base surface 78, and it can beconfigured to allow a relatively small sealing element to extend throughthe base 26 and have its distal end substantially co-planar with distalends of any other sealing elements extending through the base 26. Asillustrated in this embodiment, the recessed portion 98 of the base 26can be in communication with the cut-out portion 82 a formed in thecircumferential wall 82 of the proximal base portion 26 a, which canallow greater flexibility in angular insertion of a surgical instrumentthrough the second port opening 80 b within the recessed portion 98. Acircumferential wall 102 of the housing 16 can include one or morecut-out portions (not shown) configured to correspond in radial locationto the one or more cut-out portions 82 a formed in the base 26 when thehousing 16 and the base 26 are attached to the retractor 18 to furtherease insertion of surgical instruments through the base 26.

The sealing ports 12 a, 12 b, 14 a, 14 b can be attached or mated to theseal base 26 using any attachment or mating mechanism known in the art,but in the illustrated embodiment the fixed sealing ports 12 a, 12 beach mate with the seal base 26 using engaging pins and holes, while themovable sealing ports 14 a, 14 b each mate with the seal base 26 throughan interference fit between the proximal and distal base portions 26 a,26 b. In general, the first and second fixed sealing ports 12 a, 12 band the first and second movable sealing ports 14 a, 14 b can eachinclude a port housing, which can be seated directly or indirectly inone of the port openings 80 a, 80 b, 80 c, 80 d in the seal base 26, anda sealing element, which can be positioned within an associated porthousing. A sealing element can include at least one instrument sealand/or at least one channel seal, and can generally be configured tocontact an instrument inserted through the sealing element's associatedsealing port.

As shown in FIGS. 6 and 8-10 and discussed further below, the firstfixed sealing port 12 a can include a first port housing, which can beseated within the first port opening 80 a in the seal base 26, and afirst sealing element, which can be positioned within the first porthousing. The first port housing can include a crown 112, a gasket ring114, and a retainer ring 116. The first sealing element can include afirst distal seal 20 and a proximal seal including a multi-layer conicalseal 104 positioned proximal to the first distal seal 20 and amulti-layer protective member 108 disposed on a proximal surface of theconical seal 104. The second fixed sealing port 12 b can include asecond port housing, which can be seated within the second port opening80 b in the seal base 26, and a second sealing element, which can bepositioned within the second port housing. The second port housing caninclude a press cap 126. The second sealing element can include a seconddistal seal 22, and a proximal seal including a lip seal 132 positionedon a proximal end of the distal seal 22 and a multi-layer protectivemember 124 positioned proximal to the lip seal 132. The first and secondmovable sealing ports 14 a, 14 b can respectively include first andsecond supports or movable port housings, which can be respectivelyseated in the third and fourth port openings 80 c, 80 d in the seal base26, and first and second movable sealing elements, which can berespectively positioned within their respective movable port housings.The first and second supports or movable port housings can each includea proximal cap, a seal retainer, an eccentric seal, and an eccentricbase. The first and second movable sealing elements can each include adistal seal, a lip seal positioned on a proximal end of the distal seal,and a multi-layer protective member positioned proximal to the lip seal.

The various port housings and sealing elements of the fixed and movablesealing ports 12 a, 12 b, 14 a, 14 b can have a variety of sizes,shapes, and configurations. A person skilled in the art will appreciatethat while channel or zero-closure seals in the form of duckbill sealsare shown for each of the distal seals 20, 22, 24 a, 24 b, any seal,e.g., duckbill seals, cone seals, flapper valves, gel seals, diaphragmseals, lip seals, iris seals, non-linear sealing elements such sealingelements with an S-shaped opening, etc., same or different from anyother of the other distal seals 20, 22, 24 a, 24 b can be used and canbe aligned in any way relative to the base 26. Generally, a zero-closureseal can be configured to form a seal in a working channel when noinstrument is disposed therethrough to thus prevent the leakage ofinsufflation gases delivered through the surgical access device to thebody cavity. A duckbill seal can generally have opposed flaps thatextend at an angle toward one another in a distal direction and thatcome together at a distal end to form a seal face. The opposed flaps canbe movable relative to one another to allow the seal face to movebetween a closed position, in which no instrument is disposedtherethrough and the seal face seals the working channel of the surgicalaccess device, and an open position in which an instrument is disposedtherethrough. A duckbill seal can include various other features, asdescribed in more detail in U.S. application Ser. No. 11/771,263,entitled “Duckbill Seal with Fluid Drainage Feature,” filed on Jun. 29,2007, which is hereby incorporated by reference in its entirety. Inaddition, the seal face of the duckbill seal can be in any nonlinearshape or configuration known in the art, for example in an S-shapedconfiguration, as described in more detail in U.S. Pat. No. 5,330,437,entitled “Self Sealing Flexible Elastomeric Valve and Trocar Assemblyfor Incorporating Same,” filed Nov. 12, 1993, which is herebyincorporated by reference in its entirety.

As mentioned above and as illustrated in FIG. 8, the first fixed sealingport 12 a can include the first port housing and the first sealingelement. The multi-layer conical seal 104 of the first sealing elementcan include a series of overlapping seal segments 106 that are assembledin a woven arrangement to provide a complete seal body. The sealsegments 106 can be stacked on top of one another or woven together inan overlapping fashion to form the multi-layer seal 104 having a centralopening (not shown) therein. The seal segments 106 can be made from anynumber of materials known to those skilled in the art, but in anexemplary embodiment the seal segments 106 are formed from anelastomeric material. The multi-layer protective member 108 cansimilarly be formed from a series of overlapping segments 110 that aredisposed proximal to the overlapping seal segments 106 and that areconfigured as anti-eversion elements to protect the seal segments 106from damage caused by surgical instruments passed through the opening inthe multi-layer seal 104. The protective member 108 can also be formedfrom various materials, but in certain exemplary embodiments theprotective member 108 is formed from a molded thermoplastic polyurethaneelastomer, such as Pellethane™.

The segments 106, 110 that form the multi-layer seal 104 and theprotective member 108 can be held together using various techniquesknown in the art. As shown in FIG. 8, the segments 106, 110 can be heldtogether by a plurality of ring members that mate to engage the segments106, 110 therebetween. In particular, the protective member 108 can beengaged between the crown 112 and the gasket ring 114, and the seal 104can be engaged between the gasket ring 114 and the retainer ring 116.Pins 118 can be used to mate the ring members 112, 114, 116 and toextend through and engage the segments 106, 110 of the seal 104 and theprotective member 108. In some embodiments, an o-ring (not shown) can bepositioned between the retainer ring 116 and the seal base 26 to ensurean air and liquid tight seal between the same.

When fully assembled, the first port housing can be disposed at variouslocations within the surgical access device 10, e.g., in the first portopening 80 a formed in the base 26. As shown in FIGS. 6 and 8, the firstport housing can include one or more distally extending seating pins,e.g., five pins 120 distally extending from the retainer ring 116, thatare configured to be received in one or more corresponding slots formedin the base 26, e.g., five slots 122 formed in the distal base portion26 b, to properly position the first fixed sealing port 12 a relative tothe base 26. As mentioned above, the first fixed sealing port 12 a canalso include the first distal seal 20, which can have a proximal flangethat is captured between the retainer ring 116 and the distal seal baseportion 26 b to secure the first distal seal 20 therebetween. In use, asurgical instrument can be passed through a center opening of theprotective member 108 and the multi-layer seal 104, and the sealsegments 106, 110 can engage and form a seal around an outer surface ofthe instrument to thereby prevent the passage of fluids and gas throughthe seal. When no instrument is disposed therethrough, the centeropening will generally not form a seal in the working channel, howeverother configurations in which a seal is formed when no instrument isdisposed therethrough are also conceivable. Exemplary instrument sealconfigurations are described in more detail in U.S. Patent PublicationNo. 2004/0230161 entitled “Trocar Seal Assembly,” filed on Mar. 31,2004, and U.S. patent application Ser. No. 10/687,502 entitled “ConicalTrocar Seal,” filed on Oct. 15, 2003, which are hereby incorporated byreference in their entireties. The instrument can be further insertedthrough the sealing element, e.g., through the first distal seal 20.When no instrument is disposed therethrough, the first distal seal 20can be configured to form a seal in the working channel, however otherconfigurations in which a seal is not formed without an instrument isdisposed therethrough are also conceivable.

The second fixed sealing port 12 b can generally be configured and usedas an instrument seal similar to the first fixed sealing port 12 a. Inthis illustrated embodiment, as shown in FIG. 9, the second fixedsealing port 12 b can include the second port housing configured to matewith the base 26 and can include the second sealing element configuredto be disposed between the second port housing and the base 26. Thesecond fixed sealing port 12 b can generally have the multi-layerprotective member 124 disposed on a proximal surface of the press cap126. The press cap 126 can be configured to mate with the seal base 26using a mating mechanism, e.g., pins 128 distally extending from thepress cap 126 configured to engage corresponding holes 130 formed in theseal base 26. The second distal seal 22 with the lip seal 132 disposedon a proximal surface thereof can be secured between the press cap 126and the seal base 26. The multi-layer protective member 124 can alsomate to the seal base 26 to help fixedly secure the second fixed sealingport 12 b within the second port opening 80 b formed in the base 26 byusing an attachment mechanism such as pins 134 proximally extending fromthe seal base 26 that are configured to engage corresponding holes 136formed in the multi-layer protective member 124.

The first movable sealing port 14 a can generally be configured and usedas an instrument seal similar to the first and second fixed sealingports 12 a, 12 b. However, in contrast to the fixed sealing ports 12 a,12 b, the first movable sealing port 14 a can be configured to bemovably rather than fixedly attached to the seal base 26. The firstmovable sealing port 14 a can include the first movable port housinghaving a circular shape with the first movable sealing element disposedtherein. As illustrated in FIG. 10, the third sealing port 14 a cangenerally have a multi-layer protective member 138 positioned between aproximal cap 140 and a seal retainer 144. The multi-layer protectivemember 138 can be formed from a series of overlapping segments 142 thatare configured as anti-eversion elements to protect the seal segments142 from damage caused by surgical instruments passed through the firstmovable sealing port 14 a. The proximal cap 140 and the seal retainer144 can be configured to mate together with the protective member 138positioned therebetween using a mating mechanism such as one or more capretaining pins 156 distally extending from a distal surface 148 of theproximal cap 140 that are configured to engage one or more correspondingcap retaining pin openings 158 formed in the seal retainer 144. One ormore leaf pins 146 distally extending from the distal surface 148 of theproximal cap 140 can be configured to pass through leaf segment openings160 formed in the seal segments 142 and to engage one or morecorresponding leaf pin openings 150 formed in the seal retainer 144 toretain the protective member 138 in a fixed position relative to theproximal cap 140 and the seal retainer 144.

A proximal movable port assembly including the protective member 138,the proximal cap 140, and the seal retainer 144 can be configured tomate with a distal movable port assembly including an eccentric ring 152and an eccentric base 154, with the first movable distal seal 24 apositioned between the seal retainer 144 and the eccentric base 154. Thefirst movable distal seal 24 a having a lip seal 164 positioned on aproximal end thereof can be disposed between opposed seal elementopenings 176 a, 176 b respectively formed in the seal retainer 144 andthe eccentric base 154. The first movable distal seal 24 a and the lipseal 164 coupled to the proximal end thereof, as well as the multi-layerprotective member 138, can thereby be eccentric relative to the firstmovable port housing. The seal element openings 176 a, 176 b can be incommunication with a seal opening 178 formed in the proximal cap 140 toallow a surgical instrument to be inserted through the seal opening 178in the proximal cap 140 and into the first movable distal seal 24 a. Theseal element openings 176 a, 176 b and the seal opening 178 can define acentral axis that is offset from a central axis or center-point 81 ofthe first movable port housing, which corresponds to a central axis orcenter-point 81 of the third port opening 80 c in which the firstmovable port housing is seated, as illustrated in FIGS. 2, 6, and 10.One or more seal pins 162 proximally extending from a proximal surfaceof the eccentric base 154 can be configured to be positioned radiallyaround the sealing element including a lip seal 164 positioned on aproximal end thereof, to pass through one or more seal pin openings 168formed in the eccentric ring 152, and to engage one or morecorresponding seal pin openings 170 formed in a distal surface 172 ofthe seal retainer 144. An alignment mechanism can be configured toproperly align the seal retainer 144 and the eccentric base 154 relativeto one another, e.g., one or more locating pins 166 distally extendingfrom the distal surface 172 of the seal retainer that are configured toengage one or more corresponding locating pin channels 174 formed in theeccentric base 154.

The second movable sealing port 14 b in the illustrated embodiment canbe configured and used similar to the first movable sealing port 14 a,although a person skilled in the art will appreciate that the first andsecond movable sealing ports 14 a, 14 b can be configured different fromone another.

As shown in FIG. 3, the seal base 26 and the housing 16 can have aheight H that is less than a longitudinal length of the device's sealingelements. In such a configuration, one or more of at least the fixedsealing elements can be oriented to minimize contact with the retractor18. For non-limiting example, each of the fixed distal seals 20, 22 canbe aligned with their respective distal sealing element openings 20 a,22 a tangential to a nearest portion of a circumference of the housing16 and the retractor 18 extending from the housing 16 as shown in FIGS.3 and 4. In other words, the distal sealing element openings 20 a, 22 acan extend in a direction that is substantially parallel to a closestportion of a circumference of the housing 16, and not transverse to thehousing 16. Such an alignment can help prevent the distal sealingelement openings 20 a, 22 a from being pushed open by an inner wall ofthe retractor's inner elongate portion 42 when the seal base 26 is movedrelative to the retractor 18. In some embodiments, the seal base 26and/or the housing 16 can have a height H to accommodate a full lengthof the sealing elements to prevent the sealing elements from coming intocontact with the interior of the retractor 18.

As mentioned above, the first and second fixed sealing ports 12 a, 12 b,including their respective port housings and respective sealingelements, can be configured to be in a fixed position relative to thebase 26 and to rotate with the base 26 relative to the housing 16 andthe retractor 18. On the other hand, the first and second movablesealing ports 14 a, 14 b, including their respective port housings andrespective movable sealing elements, can be movable within theirrespective port openings 80 c, 80 d relative to the base 26 and hencealso relative to the fixed sealing ports 12 a, 12 b. The first andsecond movable sealing ports 14 a, 14 b can also be configured to bemovable independent of one another and when individually moved can causerotational movement of the base 26, and/or cause rotational and/orlateral movement of the other one of the movable sealing ports 14 a, 14b when a surgical instrument is inserted through the other one of themovable sealing ports 14 a, 14 b and is held in a substantially fixedposition therein.

The first movable sealing port 14 a including the first movable porthousing and the first movable sealing element can be configured to berotatably movable relative to the base 26, the housing 16, and theretractor 18 by rotating within the third opening 80 c in a firstdirection M1, e.g., clockwise, and/or in a second, opposite directionM1′, e.g., counterclockwise. Being mated to the seal base 26, the firstmovable port housing can also be configured to be rotatable around thecenter-point 94 of the base 26 in a first direction M2, e.g., clockwise,and/or in a second, opposite direction M2′, e.g., counterclockwise. Inthis way, the first movable sealing port 14 a can be configured to havedual rotational motion by being separately or concurrently rotatablearound the third port opening's center-point 81 and around the base'scenter-point 94. The first movable sealing port 14 a can thus beconfigured to independently rotate around the port opening center-points81 in the first and/or second directions M1, M1′, to independentlyrotate around the base center-point 94 in the first and/or seconddirections M2, M2′, and to simultaneously rotate with the base 26 andwithin third port opening 80 c, thereby helping to provide for optimalpositioning of a surgical instrument inserted through the first movablesealing port 14 a. In the illustrated embodiment, the first movable porthousing can rotate 360° in each of the first and second directions M1,M1′, and the base 26 can rotate 360° in each of the first and seconddirections M2, M2′. Although, a person skilled in the art willappreciate that the first movable port housing can be configured torotate any number of degrees in either of the directions M1, M1′ andthat the base 26 can be configured to rotate any number of degrees ineither of the directions M2, M2′.

Because the first movable port housing can be held by interference fitwithin the base 26, the first movable port housing can be configured tobe rotatably movable relative to the base 26, the housing 16, and theretractor 18, e.g., around the center-point 81 of the third port opening80 c and the first movable port housing, but not be laterally movable ororbital relative to the base 26, the housing 16, or the retractor 18.However, the first movable sealing element of the first movable sealingport 14 a can be configured to be both rotationally movable andlaterally movable relative to the base 26, the housing 16, and theretractor 18. In other words, the first movable sealing element can beconfigured to rotate within the third port opening 80 c as the firstmovable port housing rotates and thereby laterally move or orbit in aplane parallel to a plane of the base's proximal surface 78. Asmentioned above, the first movable sealing port 14 a can be configuredto not be substantially vertically movable, e.g., distally or proximallymovable, within the third port opening 80 c, but as will be appreciatedby a person skilled in the art, the spring assembly 32, discussedfurther below, can allow a small amount of vertical movement of thefirst movable sealing port 14 a.

The first movable sealing element can be configured to be laterallymovable in a predetermined orbital path defined by the third portopening 80 c in which the first movable sealing port 14 a is disposed.The predetermined orbital path of the first movable sealing element canhave any shape and size, but as shown in this embodiment in FIGS. 2, 6,7A, and 7B, the predetermined orbital path can generally be defined by aperimeter 92 c of the third port opening 80 c formed in the base 26,e.g., defined by a circle having the third diameter D3. Because thefirst movable sealing element is eccentric with the first movable porthousing, i.e., is positioned off center in the first movable porthousing, the predetermined orbital path can be defined by the third portopening 80 c in the base 26 but it can be smaller than the thirddiameter D3 of the third port opening 80 c, e.g., have an orbital pathdiameter of about 18 mm versus the third diameter D3 of about 25 mm.

The second movable sealing port 14 b can be movable similar to the firstmovable sealing port 14 a. Generally, the second movable port housing ofthe second movable sealing port 14 b can be configured to rotaterelative to the base 26, the housing 16, and the retractor 18 with thesecond movable sealing element of the second movable sealing port 14 balso being configured to laterally move or orbit in a predeterminedorbital path defined by a perimeter 92 d of the fourth port opening 80d.

As mentioned above, the device 10 can be configured such that movementof the base 26 relative to the housing 16 and the retractor 18 andmovement of either of the first and second movable sealing ports 14 a,14 b, and hence also lateral movement of the respective first and secondmovable sealing elements, relative to the base 26, the housing 16,and/or the retractor 18 can cause movement of at least one other of thebase 26 and the first and second movable sealing ports 14 a, 14 brelative to at least the retractor 18. Such responsive movement of atleast one of the base 26, the first movable sealing port 14 a, and thesecond movable sealing port 14 b can allow for surgical instrumentsinserted through the device 10 into a body cavity to dynamically adjusttheir positions, thereby helping to reduce the “chopstick effect” ofinterference between the instruments in the body cavity and to maximizean amount of working space available to each of the instruments.

Although the base 26 can be configured to be movable relative to thehousing 16 and the retractor 18 with or without any instruments insertedthrough any of the ports 12 a, 12 b, 14 a, 14 b, e.g., by being manuallyrotated by hand, the base 26 can also be configured to move relative tothe housing 16 and the retractor 18 in response to motion of at leastone instrument inserted through one of the ports 12 a, 12 b, 14 a, 14 b.

As shown in one embodiment of surgical access device movement in FIGS. 2and 11, the first movable sealing port 14 a can be configured to rotatein the second direction M1′ relative to the base 26, the housing 16, andthe retractor 18 (not visible in FIGS. 2 and 11) from a first positionshown in FIG. 2 to a second position shown in FIG. 11. During suchrotation, the first movable port housing including the proximal cap 140moves in the second direction M1′ around the center-point 81 of thefirst movable port housing by rotating within the third port opening 92c. The first movable sealing element can also rotationally move in thesecond opposite direction M1′, with the first movable sealing elementalso laterally moving or orbiting an angle β around its orbital pathfrom a first position (FIG. 2) to a second, different position (FIG.11). With such lateral or orbital movement, the first movable sealingelement can move from the first position that is a first distance A fromthe base center-point 94 to the second position that is a second,different distance B from the base center-point 94. The second distanceB is greater than the first distance A in this illustrated embodiment,but the first movable sealing element can laterally move such that thesecond distance B is less than the first distance A or such that thefirst and second distances A, B are equal.

The second movable sealing port 14 b can be configured to rotationallyand laterally move similar to the first movable sealing port 14 a. Inresponse to movement of the first movable sealing port 14 a, the secondmovable sealing port 14 b and/or the base 26 can be configured torotationally move relative to the housing 16 and the retractor 18,and/or the other movable sealing port 14 b with a surgical instrument isinserted therethrough and held in a fixed position therein can beconfigured to laterally move relative to the base 26. In thisillustrated embodiment, the base 26 and the second movable sealing port14 b are in substantially the same position relative to the retractor 18and the second movable sealing port 14 b is in the same positionrelative to the base 26 when the first movable sealing port 14 a is inboth the first and second positions, shown in FIGS. 2 and 11respectively. The base 26 and the second movable sealing port 14 b canremain in substantially the same position when the first movable sealingport 14 a moves from the first position to the second position for avariety of reasons, such as instruments inserted through other ports inthe base 26 already being optimally positioned or the first movablesealing port 14 a not rotating at a large enough angle β to causemovement of either the base 26 or the second movable sealing port 14 b.

As shown in another embodiment of surgical access device movement inFIGS. 2 and 12, the base 26 can be configured to rotate relative to theretractor 18 (not visible in FIGS. 2 and 12) in the second direction M2′around the center-point 94 of the base 26 from a first position (FIG. 2)to a second position (FIG. 12). Perpendicular first and secondhorizontal axes A1, A2 that intersect at the center-point 94 of the base26, help indicate the rotational movement of the base 26 relative to theretractor 18. A horizontal axis A3 of the base 26 passing through thecenter-point 94 of the base 26 and a center-point 95 of the first fixedsealing port 12 a can be aligned with the second perpendicularhorizontal axis A2 when the base 26 is in the first position shown inFIG. 2 and can move an angle α from the second horizontal axis A2 whenthe base 26 has been moved to the second position shown in FIG. 12.Movement of base 26 relative to retractor 18 can, as shown, also moveany or all of the device's ports 12 a, 12 b, 14 a, 14 b, 28 relative tothe retractor 18. While the movable sealing ports 14 a, 14 b can beconfigured to move relative to the base 26 in response to movement ofthe base 26, e.g., rotational movement of the movable port housings, inthis illustrated embodiment, the movable sealing elements can beconfigured to stay in a substantially fixed position in response tomovement of the base 26, such as shown here with the movable sealingports 14 a, 14 b being in substantially the same position relative tothe base 26 with the base 26 in both the first and second positions ofFIGS. 2 and 12. When a surgical instrument (not shown in FIGS. 2 and 12)is inserted through a movable sealing element and held in asubstantially fixed position therein when the base 26 rotates, themovable port housing associated with that movable sealing element canrotate relative to the base 26 while the movable sealing element canstay in substantially the same position, thereby allowing the instrumentinserted therethrough to remain in substantially the same position. Themovable sealing elements can remain in substantially the same positionrelative to the base 26 for other reasons when the base 26 rotates, suchthe base 26 not rotating at a large enough angle α to cause rotationalmotion of either of the movable sealing ports 14 a, 14 b.

In another embodiment of surgical access device movement illustrated inFIGS. 2 and 13, the second movable sealing port 14 b can be configuredto rotate relative to the base 26, the housing 16, and the retractor 18(not visible in FIGS. 2 and 13) at an angle δ in the first direction M1from a first position (FIG. 2) to a second position (FIG. 13). The angleδ is defined by the position of the second movable sealing port 14 brelative to the former position of the first horizontal axis A1, labeledA1′ in FIG. 13, passing through a center axis or center-point 83 of thesecond movable sealing port 14 b. As discussed above, the second movablesealing element of the second movable sealing port 14 b can laterallymove and rotationally move in the first direction M1. In thisillustrated embodiment, the base 26 and the first movable sealing port14 a both move in response to movement of the second movable sealingport 14 b. The base 26 moves relative to the housing 16 and theretractor 18 in response to movement of the second movable sealing port14 b by rotating an angle γ in the first direction M2. The firstdirections M1, M2 of the second movable sealing port 14 b and the base26, respectively, can correspond, e.g., can both be clockwise, becauselateral motion of the second movable sealing element of the secondmovable sealing port 14 b in the first direction M1 can assert asimilarly directed force against the base 26 and cause the base 26 tomove in the first direction M2. Similarly, the first movable sealingport 14 a moves relative to the base 26, the housing 16, and theretractor 18 in response to movement of the second movable sealing port14 b by rotating in the first direction M1. The first movable sealingport 14 a can be configured to dynamically move by the angle δ that thesecond movable sealing port 14 b moved or dynamically move by another,different angle.

In use, one or more surgical instruments can be inserted into a bodycavity through the surgical access device 10, which can help optimallyposition the surgical instruments relative to the body cavity throughmovement of the base 26 and/or movement of one or both of the movablesealing ports 14 a, 14 b. The device 10 can be positioned within tissueto provide access to a body cavity underlying the tissue in a variety ofways. In one embodiment, the device 10 can be positioned in tissue fullyassembled in the default state shown in FIG. 1. In another embodiment,the device 10 can be positioned partially assembled in tissue and befully assembled with a portion of the device 10 positioned in thetissue.

As illustrated in one embodiment in FIGS. 18-20, the retractor 18 can bepositioned within an opening or incision formed in tissue 180, e.g., inthe umbilicus, with proximal and distal flanges 46, 40 of the retractor18 positioned on opposed sides of the tissue 180. As shown in FIG. 18,the proximal retractor base 38 in the proximal portion of the retractor18 can be positioned on one side of the tissue 180 with a distal base 38a (see FIG. 5) of the proximal retractor base 38 positioned on and/orproximal to a proximal surface 180 a of the tissue 180. The distalflange 40 of the retractor 18 can be positioned on and/or distal to adistal surface 180 b of the tissue 180 in a body cavity 182 underlyingthe tissue 180. The inner elongate portion 42 of the retractor 18 canthereby be positioned within the tissue 180 with an inner lumen orworking channel 35 of the retractor 18 extending through the tissue 180to provide a path of access to the body cavity 182.

With the retractor 18 positioned in the tissue 180, the spring assembly32 can be positioned within the proximal retractor base 38 with thedistal spring retaining ring 32 a engaging the interior ledge 54 of theproximal retractor base 38, as illustrated in FIG. 19. The seal spring32 b can be positioned proximal to the distal spring retaining ring 32 awith the proximally extending portions 56 a of the seal spring 32 bpositioned above or proximal to the distal spring retaining ring'sdimples 58. The proximal spring retaining ring 32 c can be positionedproximal to the seal spring 32 b with the proximal spring retainingring's dimples 60 positioned above or proximal to the distally extendingportions 56 b of the seal spring 32 b. A person skilled in the art willappreciate that although the spring assembly 32 is shown in FIG. 19fully disposed in the proximal retractor base 38, because the springassembly 32 can be resilient, the spring assembly 32 can partiallyextend out of the proximal retractor base 38 until the seal base 26 andthe housing 16 are attached to the retractor 18. In some embodiments,the spring assembly 32 can be resilient and/or sized large enough to notbe fully disposed within the proximal retractor base 38 even with theseal base 26 and the housing 16 attached to the retractor 18.

With the retractor 18 positioned in the tissue 180 and the springassembly 32 positioned in the retractor 18, the seal base 26 and thehousing 16 can be attached to the retractor 18 to fully assemble thedevice 10, as shown in FIG. 20. If the tissue 180 and/or the retractor18 are adequately flexible, the retractor 18 can be angled or pivoted asshown in FIGS. 19 and 20 to a desired position to ease attachment of theseal base 26 and the housing 16 to the retractor 18. The retractor 18can also be angled or pivoted during use of the device 10 with one ormore surgical instruments inserted therethrough. To mate the seal base26 and the housing 16 to the retractor 18, the base 26 can be positionedproximal to the spring assembly 32 with a distal surface of the base 26,e.g., a distal side of the lip 52, engaging the proximal springretaining ring 32 c of the spring assembly 32. In this illustratedembodiment, the base 26 is not configured to lock to the retractor 18without an engagement and release mechanism releasably locking thehousing 16 to the retractor 18, so the base 26 can be held in positionwhile the base 26 is disposed in an inner passageway or working channel15 extending through the housing 16 and the housing 16 is attached tothe retractor 18. As mentioned above, the bayonet pins 34 of the housing16 can be positioned in the slots 36 of the proximal retractor base 38,and the housing 16 can be rotated relative to the retractor 18 to lockthe housing 16 and the base 26 thereto. The tissue 180 can provideadequate tension such that the retractor 18 need not be held in positionwhile the housing 16 is rotated relative thereto, although the retractor18 can be so held to help provide support to the device 10 during itsassembly.

With the surgical access device 10 assembled and positioned in thetissue 180, one or more surgical instruments can be insertedtherethrough and into the body cavity 182 where the instruments can helpperform any type of surgical procedure. FIGS. 21A, 22A, 23A, 24A, 25A,26A, and 27A illustrate one embodiment of a suture knot tying procedureusing first and second graspers 184 a, 184 b respectively insertedthrough the first and second movable sealing ports 14 a, 14 b and intothe body cavity 182. A person skilled in the art will appreciate thatthe term “grasper” as used herein is intended to encompass any surgicalinstrument that is configured to grab and/or attach to tissue or othermaterial and thereby manipulate the material, e.g., forceps, retractors,movable jaws, magnets, adhesives, stay sutures, etc. A person skilled inthe art will also appreciate that graspers or any other surgicalinstruments in any combination can be inserted through any of the fixedand movable sealing ports 12 a, 12 b, 14 a, 14 b in the device 10, e.g.,a scoping device, a surgical stapler, a clip applier, a needle knife, ascalpel, a hook knife, a bougie, a catheter, a vacuum, etc. A personskilled in the art will further appreciate that that the device 10 canbe used in a surgical procedure in which one or more surgicalinstruments can be introduced into a body of a patient through one ormore natural and/or artificial orifices. For ease of illustration, thetissue 180 in which the device 10 is disposed is not shown in FIGS. 21A,22A, 23A, 24A, 25A, 26A, and 27A, nor are any devices shown that can beinserted through any of the fixed sealing ports 12 a, 12 b and theinsufflation port 28 during the suture knot tying procedure. In anexemplary embodiment, a scoping device can be inserted through the firstfixed sealing port 12 a, a tissue retractor can be inserted through thesecond fixed sealing port 12 b, and working instruments, e.g., graspers,cutters, etc., can be inserted through the first and second movablesealing ports 14 a, 14 b.

As illustrated in FIG. 21A, the first and second graspers 184 a, 184 bcan be inserted through the first and second movable sealing ports 14 a,14 b, which have dynamically positioned themselves relative to the base26. As discussed above, the movable sealing ports 14 a, 14 b can adjustto any dynamic position within their respective port openings 80 c, 80d, but as shown, the first movable sealing element can be positioned ashorter distance from the first fixed sealing port 14 a than the secondmovable sealing element. A proximal handle portion 186 a of the firstgrasper 184 a can be, as shown in FIG. 21A, positioned proximal to aproximal handle portion 186 b of the second grasper 184 b with distalworking ends 188 a, 188 b of the respective first and second graspers184 a, 184 b positioned a distance. In other words, the first grasper184 a can be vertically displaced from the second grasper 184 a in aproximal direction parallel to a vertical or axial axis A4 of the base26 passing through the center-point 94 of the base 26. To help knot asuture 190 in a cut tissue 192 accessible in the body cavity 182, atleast one of the first and second grasper handle portions 186 a, 186 bcan be horizontally or radially displaced from a position parallel tothe first axis A1 to increase a distance between the distal working ends188 a, 188 b as shown by the directional arrows in FIG. 22. As one orboth of the handle portions 186 a, 186 b are moved, they can come intocontact with one other as illustrated in FIG. 22A, which can preventfurther horizontal movement of the handle portions 186 a, 186 b andhence the distal working ends 188 a, 188 b of the graspers 184 a, 184 b.To reduce interference between the handle portions 186 a, 186 b, thefirst grasper handle 186 a can be vertically moved in a proximaldirection relative to the second grasper handle 186 b, thereby allowingfor additional horizontal displacement of the first distal working end188 a relative to the second distal working end 188 b as indicated bythe directional arrow in FIG. 23A. Such horizontal displacement betweenthe distal working ends 188 a, 188 b can allow the suture 190 to betightened and knotted against the cut tissue 192.

Because of the movable configuration of the movable sealing ports 14 a,14 b that allows their respective sealing elements to move relative tothe base 26 and the housing 16, instruments inserted through the movablesealing ports 14 a, 14 b can minimally move vertically and/orhorizontally while used in a surgical area that can have a limitedworking space, particularly in minimally invasive surgical procedures.In the illustrated suture tying procedure, the first grasper handleportion 186 a need not be vertically displaced by a significant amountrelative to the second grasper handle portion 186 b to provide foradequate horizontal displacement of the distal working ends 188 a, 188b. The distal working ends 188 a, 188 b can thus, as illustrated inFIGS. 24A, 25A and 26A, be separated by a relatively small verticaldistance V and a relatively small horizontal distance H. The proximalhandle portions 184 a, 184 b can also be separated by a relatively smallvertical distance, as illustrated in FIG. 27A. Despite being configuredto reduce the need for vertical and horizontal movement of instrumentsinserted through the movable sealing ports 14 a, 14 b, the movablesealing ports 14 a, 14 b can nevertheless be configured to allow for a360° working area for surgical instruments inserted therethrough. In theillustrated suture tying procedure, as shown in FIG. 26A, the first andsecond graspers 184 a, 184 b can be movable through movement of any oneor more of the movable sealing ports 14 a, 14 b and the base 26 toaccess any location within a circular perimeter 194 with which thedevice 10 is eccentric or concentric.

In contrast, FIGS. 21B, 22B, 23B, 24B, 25B, 26B, and 27B, whichrespectively correspond to FIGS. 21A, 22A, 23A, 24A, 25A, 26A, and 27A,illustrate the first and second graspers 184 a, 184 b inserted through asurgical access device 10B configured similar to the surgical accessdevice 10 but, instead of having the first and second movable sealingports 14 a, 14 b, has first and second fixed sealing ports 14 aB, 14 bBhaving a fixed distance X therebetween. Moving the first grasper 184 ahorizontally, as shown in FIG. 22B, results in interference between thefirst and second graspers 184 a, 184 b. Moving the first grasper handleportion 186 a horizontally and vertically as illustrated in FIG. 23B canprovide clearance of the first grasper 184 a around the second grasper184 b, but as shown in FIGS. 24B, 25B, 26B, and 27B, movement of thefirst grasper 184 a around the second grasper 184 b is limited. Ahorizontal distance HB between the distal working ends 188 a, 188 b canbe substantially the same as discussed above for the graspers 184 a, 184b inserted through the device 10, but a vertical distance VB between thedistal working ends 188 a, 188 b is larger than the vertical distance Vfor the graspers 184 a, 184 b inserted through the device 10.Additionally, the distal working ends 188 a, 188 b inserted though thefirst and second fixed sealing ports 14 aB, 14 bB cannot access a 360°working area around the device 10B but instead have an inaccessible “pieslice” 189 in a circular perimeter 194B with which the device 10B iseccentric or concentric.

At any point before, during, or after a surgical procedure, the housing16, the base 26, and the spring assembly 32 can be released from theretractor 18, and the retractor 18 can be removed from the tissue 180.To disengage the housing 16 from the retractor 18, the housing 16 can berotated relative to the housing 16 in the opposite direction from whichthe housing 16 was rotated to attach the housing 16 to the retractor 18,e.g., in a counter clockwise direction as shown by the dotteddirectional arrow in FIG. 20. The engagement and release mechanism canthereby be disengaged, e.g., the bayonet pins 34 can be disengaged fromthe slots 36, to allow the housing 16 to be removed from the retractor18, also as shown by the directional arrow in FIG. 20. As mentionedabove, the tissue 180 can provide adequate tension for the rotationalmotion of the housing 16.

With the housing 16 disengaged from the retractor 18, the base 26 andthe spring assembly 32 can be proximally lifted and removed fromengagement with the retractor 18, as illustrated in FIG. 28 with thebase 26 and the spring assembly 32. With the proximal portion 30 of thedevice 10 disengaged from the retractor 18, the retractor 18 through theworking channel 35 can still provide access to the body cavity 182underlying the tissue 180. One or more surgical instruments can beadvanced through the working channel 35, such as a waste removal bag 196configured to hold waste material, e.g., dissected tissue, excess fluid,etc., from the body cavity 182. The bag 196 can be introduced into thebody cavity 182 through the retractor's working channel 35 or otheraccess port. A person skilled in the art will appreciate that one ormore surgical instruments can be advanced through the retractor'sworking channel 35 before and/or after the proximal portion 30 of thedevice 10 has been attached to the retractor 18.

FIGS. 30-33 illustrate another exemplary embodiment of a surgical accessdevice 200 that includes at least one fixed sealing port and at leastone movable sealing port. The surgical access device 200 can beconfigured and used similar to the surgical access device 10 discussedabove and can include the housing 16, the singular seal member 72 ofFIG. 15, and the retractor 18. The device 200 can also include a sealbase 226 including a proximal portion 203 similar to the seal base 26and the proximal portion 26 a discussed above. However, in thisembodiment a distal portion of the seal base 226 is in the form of aguide ring 201 attached to the proximal portion 203. A proximalattachment surface 201 a of the guide ring 201 can be fixedly attachedto a distal attachment surface 203 a of the proximal seal base 203 witha distal surface 252 b of a lip 252 extending from the proximal sealbase 203 seated on an upper outer perimeter 201 b of the guide ring 201.As will be appreciated by a person skilled in the art, the guide ring201 and the proximal seal base 203 can be otherwise fixedly attachedtogether or can be removably attached together. Similar to thosediscussed above, the seal base 226 can have an insufflation port 228,one or more fixed sealing ports 212, and one or more movable sealingports 214.

Generally, the guide ring 201 can be configured to help align thehousing 16 with the retractor 18. The guide ring 201 can, as shown inthis illustrated embodiment, have a circular shape with a skirt 205distally extending from the upper outer perimeter 201 b of the guidering 201. The skirt 205 can include a plurality of cut-outs 207 formedtherein that are each configured to align with a corresponding one ofthe slots 36 of the retractor 18 when the base 226 is coupled thereto.The cut-outs 207 can thus each have a size, shape, and position around aperimeter of the guide ring 201 to complement one of the slots 36. Oneor more of the cut-outs 207, such as each of the cut-outs 207 in thisillustrated embodiment, can extend into the guide ring's upper outerperimeter 201 b to provide adequate clearance for the bayonet pins 34 onthe housing 16 to be disposed in and removed from the slots 36. The sealbase 226 can be positioned in a variety of radial configurations withrespect to the retractor 18 before and/or after the engagement andrelease mechanism is engaged to attach the base 226 to the retractor 18,with the cut-outs 207 selectively aligned with any of the slots 36, suchas in this illustrated embodiment having four radial configurationsabout 90° apart using the four equidistantly spaced radial slots 36,pins 34, and cut-outs 207. In this way, the initial position of the sealbase 226 can be predictable with respect to the retractor 18 when thehousing 16 attaches the seal base 226, which can help desirably positionthe ports extending through the base 226 with respect to the surgicalsite.

The device 200 can be assembled with or without a portion of the device200, e.g., the retractor 18, positioned in tissue. To assemble thedevice 200, the singular seal member 72 can be seated on the interiorledge 54 of the retractor 18 such that the singular seal member 72 is atleast partially disposed within the retractor 18. The seal base 226 canbe positioned to engage the retractor 18 with the singular seal member72 positioned therebetween. As illustrated in FIG. 33, the singular sealmember 72 can deform to conform to a shape of the retractor 18 and/orthe seal base 226. An inner surface of the skirt 205 can be positionedto engage an outer surface of the proximal retractor base 38 such thatthe cut-outs 207 in the seal base 226 align with and thereby expose thebayonet slots 36. The skirt 205 can help hold the base 226 in positionwith respect to the retractor 18 until the housing 16 is attachedthereto using the pins 34 and rotation of the housing 16 with respect tothe retractor 18.

In another exemplary embodiment of a surgical access device 300,illustrated in FIG. 34, the device 300 can be configured and usedsimilar to the device 10 discussed above with a housing 316, a seal base326 having at least one fixed sealing port and at least one movablesealing port, the singular seal member 72 of FIG. 15, and a retractor318. The seal base 226 of FIGS. 30-33 can allow four radial positions,while the seal base 326 can include a modified guide ring 301 configuredto allow the seal base 326 including the modified guide ring 301 to bepositioned in eight radial configurations about 45° apart with themodified guide ring 301 having eight cut-outs 307 formed in its skirt305, the housing 316 having eight bayonet pins 334, and the retractor318 having eight bayonet slots 336.

In yet another exemplary embodiment of a surgical access device 400,illustrated in FIG. 35, a seal base 426 can be configured to bepositioned at any location around a perimeter of a retractor 418 priorto attachment of a housing 416 to the retractor 418 to lock the sealbase 426 and the housing 416 thereto. The device 400 can be configuredand used similar to the device 10 discussed above, including the housing418, the seal base 426, the hollow singular seal member 76 of FIG. 17,and the retractor 418. In this embodiment of the device 400, a proximalretractor base 438 of the retractor 38 can be configured to engage theseal base 426 using an interlocking mechanism. The interlockingmechanism can generally be configured to allow the seal base 426 to bepredictably positioned at any location around the perimeter of theretractor 418, and in this illustrated embodiment includes interlockingteeth. The seal base 426 can include a proximal portion 403 similar tothe seal base 26 and a distal portion in the form of a clocking ring 405attached to the proximal portion 403. The clocking ring 405 can beconfigured similar to the skirt 205 of FIG. 30 but it can extend arounda perimeter of the clocking ring 405 without any cut-out portions. Anexternal surface of the clocking ring 405 can include teeth 405 aconfigured to engage corresponding teeth 418 a formed on an innersurface of the retractor 418, e.g., on an internal surface of a proximalretractor base 438 of the retractor 418. In this way, the seal base 426can be positioned relative to the retractor 418 in a desired positionanywhere 360° around the retractor 418 prior to attachment of thehousing 416 to the retractor 418 to lock the base 426 thereto. Theproximal retractor base 438 can have a thickened wall to helpaccommodate the teeth 418 a, which can be integrally formed therewith.

The above exemplary embodiments of surgical access devices 10, 200, 300,400 can each include a circumferential distal lip, e.g., the lip 52 ofthe device 10, configured to help provide a seal between the seal baseand the retractor to which it is releasably attached. In anotherembodiment of a surgical access device 500, illustrated in FIG. 36, ano-ring 552 can be configured to be seated between a seal base 526 and aretractor 518 to help provide a seal therebetween. A housing 516configured to couple the base 526 and the retractor 518 can include achamfered internal surface 516 a configured to seat the o-ring 552between the housing 516 and the base 526 to provide a seal between thebase 526 and the retractor 518 when the device 500 is assembled.

In some embodiments, a surgical access can have an integrally formedseal base and housing configured to have at least one sealing port andto be removably coupled to a retractor. A surgical access device havingan integrally formed seal base and housing can be easier to assemble anddisassemble than a device having a separate seal base and housing. Asillustrated in one embodiment of a surgical access device 600, shown inFIG. 37, an integral seal base and housing 626 can have at least onefixed sealing port 612 disposed therethrough and at least one movablesealing port 614 disposed therethrough. Opposed pressure surfaces 617 ofthe integral base and housing 626 and the retractor 618 can beconfigured to provide a pressure seal 617 to help provide a seal betweenthe integral base and housing 626 and a retractor 618. The opposedpressure surfaces 617 can be configured to engage each other when theintegral base and housing 626 is attached to the retractor 618 using anengagement and release mechanism, e.g., a bayonet latch mechanism asshown in this embodiment.

As surgical instruments are inserted through the surgical access deviceembodiments described herein, a risk can exist that a particularly sharpinstrument may tear or puncture a portion of the retractor or nearbytissue. Accordingly, in any and all of the embodiments described herein,a safety shield can optionally be included to reduce the risk of tearingor puncture by a surgical instrument. In general the shield can be of amaterial that is relatively smooth and with a low coefficient offriction to allow ease of passage of instruments, but resistant totearing and puncture. For example, the shield can be formed of silicone,urethane, thermoplastic elastomer, rubber, polyolefins, polyesters,nylons, fluoropolymers, and any other suitable materials known in theart. The shield can generally provide a liner for a retractor or tissueand can be detachable from a surgical access device so it can be used asneeded in a particular procedure.

In one exemplary embodiment shown in FIGS. 38-40, a surgical accessdevice 700 has a housing 416, a seal base 726 with at least one fixedsealing port 712 and at least one movable sealing port 714 extendingtherethrough, and a retractor 718. The surgical access device 700 canalso include a shield 719 configured to extend through the retractor 718to thereby provide a protective lining as surgical instruments areinserted through the device 700. The shield 719 can have a lengthcorresponding to a length of the retractor 718, but can also have alength less than or considerably longer than the length of the retractordepending on a specific application. The shield 719 can be mated to theretractor 718 using any attachment mechanism, e.g., adhesive, screws,press fit, etc., as will be appreciated by a person skilled in the art.As illustrated, the shield 719 can be configured to engage a proximalflange 746 seated in a proximal retractor base 738 of the retractor 718that has a proximal o-ring 748 disposed therein. The proximal o-ring 748can help provide structure to the proximal flange 746 and therefore helpprovide a more stable engagement surface for the shield 719.

The shield 719 can have any size, shape, and configuration. In thisillustrated embodiment, the shield 719 includes a circumferentiallyexpandable, cylindrically-shaped member having an outer layer 719 a andan inner layer 719 b configured to be disposed within in the outer layer719 a. The outer and inner layers 719 a, 719 b can each respectivelyinclude a circumferential proximal rim 721 a, 721 b having a pluralityof flanges 723 a, 723 b extending radially outward therefrom. The outerand inner layers 719 a, 719 b can include any number of flanges 723 a,723 b, and the flanges 723 a, 723 b can be spaced equidistantly or anyother distance apart from one another around their respective proximalrims 721 a, 721 b. The outer and inner flanges 723 a, 723 b can each beconfigured to at least partially overlap to form a continuous proximalflange of the shield 719 that is configured to engage the proximalflange 746. Alternatively, as shown, a portion of the outer and innerflanges 723 a, 723 b can be configured to engage one another to form a“broken” proximal flange of the shield 719. In other embodiments, noneof the outer and inner flanges 723 a, 723 b can overlap one another whenthe inner layer 719 b is disposed in the outer layer 719 a.

The outer and inner layers 719 a, 719 b of the shield 719 can alsoinclude a plurality of respective distal elongate fingers 725 a, 725 bdistally extending from the proximal rim 721 a, 721 b and configured toat least partially overlap and engage one another when the inner layer719 b is disposed in the outer layer 719 a to form a continuous distalsurface configured to engage at least a portion of an inner wall of aninner elongate portion 742 of the retractor 718. The distal fingers 725a, 725 b can thus be configured to protect the inner elongate portion742 of the retractor 718 from damage but be configured to be selectivelymovable when in contact with a surgical instrument such that thesurgical instrument can optionally push between the distal fingers 725a, 725 b to help provide the surgical instrument with free angular rangeof motion through the device 700. The distal fingers 725 a, 725 b canalso be configured to be selectively movable when the retractor 718bends when in position in tissue, if the retractor 718 is flexible.

A shield can include a plurality of layers as discussed above, or ashield can be a singular member, which can make the shield easier todispose in a retractor. FIGS. 41 and 42 illustrate one embodiment of asingular shield 719′. The alternate shield 719′ can include acircumferential proximal rim 721′ with or without radially extendingflanges. Instead of having a plurality of fingers distally extendingfrom the proximal rim 721′, the alternate shield 719′ can include apleated distal portion 723′ that simulates distal fingers. The pleateddistal portion 723′ can have a variety of sizes, shapes, andconfigurations. As shown, the pleated distal portion 723′ can include aplurality of box pleats 723 a′ folded in the shield 719′circumferentially around the distal portion 723′. In this way, thepleated distal portion 723′ can be configured to be selectively movablewhen the retractor 719′ bends, if the retractor 719′ is flexible, and/orwhen a surgical instrument presses against an inner wall of the pleateddistal portion 723′. In another embodiment of a singular retractorshield 719″, shown in FIGS. 43-45, the shield 719″ can include a pleateddistal portion 723″ distally extending from a proximal rim 721″ andhaving a plurality of knife pleats 723 a″ formed circumferentiallytherearound.

In the surgical access device embodiments described above, each of thedevice's surgical access ports can be configured to move relative to theretractor through movement of the seal base and/or movement of a movablesealing port. However, in some surgical procedures it can beadvantageous to have at least one surgical access port configured tostay in a fixed radial position relative to the retractor. For example,during a surgical procedure tissue can be retracted away from a surgicalsite to provide more direct access to the surgical site and to protectthe retracted tissue from damage during the surgical procedure. Becausethe retracted tissue is traditionally retracted in a stable positionthroughout a surgical procedure, a retractor surgical instrument used toretract tissue also traditionally remains in a stable positionthroughout a surgical procedure, e.g., by continuous hand holding of theretractor, by mounting a retractor to a wall fixture, etc. Accordingly,in any and all of the embodiments described herein, a side access portcan optionally be included to allow a surgical instrument to be insertedthrough the surgical access device but remain in a fixed radial positionrelative to the retractor of the surgical access device to, e.g., holdretracted tissue in a stable position even during movement of the sealbase or other portion of the surgical access device.

In one exemplary embodiment shown in FIGS. 46 and 47, a surgical accessdevice 800 has a housing 816, a retractor 818 configured to couple withthe housing 816 using an engagement and release mechanism, a seal base826 with at least one fixed sealing port 812 and at least one movablesealing port 814 extending therethrough, and a spring assembly includingdistal and proximal spring retaining rings 832 a, 832 c with a sealspring 832 b positioned therebetween. Similar to that discussed above,the housing 816 and the base 826 can be movable relative to theretractor 818, and the at least one movable sealing port 814 can bemovable relative to the housing 816 and the retractor 818. The surgicalaccess device 800 can also include a side access port 831 having asealing element 820 disposed therein and configured to receive asurgical instrument 833 inserted therethrough. The side access port 831can be a fixed sealing port or a movable sealing port similar to thesealing ports discussed above, although in an exemplary embodiment theside access port 831 can be a fixed sealing port similar to the fixedsealing ports 12 a, 12 b of the device 100 of FIG. 1. A person skilledin the art will appreciate that while a grasper 833 configured toretract tissue is shown inserted through the side access port 831, anysurgical instrument can be inserted through the side access port 831 toretract tissue or perform any other function in a surgical procedure.

The side access port 831 can be formed in the retractor 818 such thatthe side access port 831 is located at a fixed radial position relativeto the retractor 818. In the illustrated embodiment, a body 837 of theside access port 831 angles proximally upwards and outwards from asidewall of the proximal retractor base 838 such that the side sealingelement 820 extending through the body 837 points toward the retractor'sworking channel 835 to allow the surgical instrument 833 insertedthrough the side access port 831 to easily access the working channel835. To accommodate the side access port 831, a proximal retractor base838 of the retractor 818 can have an extended depth to allow the sideaccess port 831 to be formed in a sidewall thereof at a fixed positionaround a perimeter thereof and allow the side access port 831 to provideaccess to a working channel 835 extending through the retractor 818. Asshown, the distal spring retaining ring 832 a engaging the proximalretractor base 838 can also have an extended depth to accommodate theside access port 831. Being formed in a sidewall of the retractor 818,as illustrated in FIG. 46, the side access port 831 can extend in aplane P1 that is offset from a plane P2 containing the base 826 throughwhich the at least one fixed and movable sealing ports 812, 814 extend.The side access port 831 can extend at any angle through the retractor818 and the distal spring retaining ring 832 a with any angle betweenthe plane P1 of the side access port 831 and the plane P2 of the base826.

The surgical instrument 833 can have a range of motion within the sideaccess port 831 dependent on its angle of insertion through the seal,e.g., in this embodiment a multi-layer protective member 808 disposed ona proximal surface of a conical seal 804 of the side access port 831.For example, as illustrated in FIG. 46, at a maximum angle of insertion,the instrument 833 a can extend through the side access port 831 andengage an inner wall of an inner elongate portion 842 of the retractor818 on a side opposed to the sidewall of the retractor 818 including theside access port 831. Similarly, at a minimum angle of insertion, theinstrument 833 b can extend through the side access port 831 and engagethe inner wall of the inner elongate portion 842 on a same side as thesidewall of the retractor 818 including the side access port 831.

The side access port 831 can also include a seal cap 839 attached to aproximal end thereof. The seal cap 839 can be configured similar to thelip seal 132 of FIG. 9 and can be configured to allow insertion of theinstrument 833 therethrough. The seal cap 839 can also be configured tocover and protect the side access port 831 when the side access port 831is not in use, e.g., when the instrument 833 is not disposedtherethrough. The seal cap 839 can be removably coupled to the sideaccess port 831, e.g., with a snap lock, for cleaning and/orreplacement.

In some embodiments, a surgical access device can include a side accessport that is at a fixed radial position relative to the device'sretractor but that is otherwise movable relative to the retractor. Asillustrated in one embodiment in FIGS. 48-51, a surgical access device900 can include a housing 916, a retractor 918, a seal base 926 with atleast one fixed sealing port 912 and at least one movable sealing port914 extending therethrough, and a spring assembly similar to the device800 of FIG. 46, but the alternate device 900 can include a radiallyfixed but rotationally and pivotally movable side access port 931 formedin a sidewall of the retractor 918 in a proximal retractor base 938.

The movable side access port 931 can be configured to be movablerelative to the retractor 918 in a variety of ways, such as by using aball and socket joint as illustrated. The retractor 918 can include asocket 941 configured to seat a ball 943 of the movable side access port931 that allows the ball 943 to slide or rotate therein. The device 900can include a releasable locking mechanism configured to lock the ball943 in a fixed position relative to the socket 941 and the retractor 918and to be released to allow the ball 943 to move relative to the socket941 and the retractor 918. The releasable locking mechanism can have avariety of configurations, e.g., engaging pins and holes, threads, alatch, a clamp, etc. In the illustrated embodiment, the releasablelocking mechanism includes complementary threads 938 a, 947 arespectively formed on the proximal retractor base 938 and on a seal cap947. The ball 943 can be adjusted to a desired position within thesocket 941 with the seal cap 947 detached from the retractor 918 orpartially threaded onto the retractor 918. When the ball 943 and hencethe side access port 931 has been adjusted to a desired position, theseal cap 947 can be tightened onto the proximal retractor base 938,e.g., by rotating the seal cap 947 clockwise relative to the retractor918, to hold the ball 943 in place until the seal cap 947 is loosened,e.g., by rotating the seal cap 947 counter clockwise relative to theretractor 918. The seal cap 947 can optionally include finger grips 951and/or other gripping mechanism, e.g., a textured surface, finger loops,etc., to help in rotating the seal cap 947. A seal can be formed betweenthe seal cap 947 and the retractor 918 in any way, e.g., with an o-ring949 positioned between the seal cap 946 and the proximal retractor base938.

Allowing movement of the side access port 931 relative to the retractor918 while maintaining a fixed radial position relative to the retractor918 can allow an instrument 933 inserted through the movable side accessport 931 to have a greater range of available motion. A person skilledin the art will appreciate that while a grasper 933 configured toretract tissue is shown inserted through the side access port 931, anysurgical instrument can be inserted through the side access port 931 toretract tissue or perform any other function in a surgical procedure.The surgical instrument 933 can have a range of motion within the sideaccess port 931 dependent on its angle of insertion through amulti-layer protective member 908 disposed on a proximal surface of aconical seal 904 of the side access port 931 and on a rotated positionof the ball 943 relative to the socket 941. For example, at a maximumangle of insertion, the instrument 933 a can extend through the sideaccess port 931 and engage an inner wall of an inner elongate portion942 of the retractor 918 on a side opposed to the sidewall of theretractor 918 including the side access port 931. Similarly, at aminimum angle of insertion, the instrument 933 b can extend through theside access port 931 and engage the inner wall of the inner elongateportion 942 on a same side as the sidewall of the retractor 918including the side access port 931. Because a sealing element 920 of theside access port 931 can be configured to move with the ball 943relative to the retractor 918, the sealing element 920 can maintain afixed, predictable position such that the instrument 933 insertedthrough the ball 943 and the sealing element 920 can extend transverselythrough the ball 943 regardless of the ball's position relative to theretractor 918. If the inner elongate portion 942 is flexible as in thisillustrated embodiment, the retractor 918 can be configured to deform orbend in response to pressure from the instrument 933, and/or any otherinstrument inserted therethrough. For non-limiting example, with theinstrument 933 in a maximized insertion position, the retractor 918 canhave a first height H1 in one portion of the retractor 918 and a second,larger height H2 in another portion of the retractor 918.

As will be appreciated by those skilled in the art, any and all of theembodiments disclosed herein can be interchangeable with one another asneeded. For example, an exemplary surgical access device kit couldinclude multiple housings and seal bases with one or more retractors.Each seal base and housing combination can have different movablesealing port configurations enabling various combinations of movablesealing port movement as needed in particular application. Variousrelease mechanism known in the art can be used to releasably attach thevarious base members and housings to a retractor.

There are various features that can optionally be included with any andall of the surgical access device embodiments disclosed herein. Forexample, a component of the device, such as a seal base, housing,retractor, etc., can have one or more lights formed thereon or around acircumference thereof to enable better visualization when insertedwithin a patient. As will be appreciated, any wavelength of light can beused for various applications, whether visible or invisible. Any numberof ports can also be included on and/or through the surgical accessdevices to enable the use of various surgical techniques and devices asneeded in a particular procedure. For example, openings and ports canallow for the introduction of pressurized gases, vacuum systems, energysources such as radiofrequency and ultrasound, irrigation, imaging, etc.As will be appreciated by those skilled in the art, any of thesetechniques and devices can be removably attachable to the surgicalaccess device and can be exchanged and manipulated as needed.

The embodiments described herein can be used in any known and futuresurgical procedures and methods, as will be appreciated by those skilledin the art. For example, any of the embodiments described herein can beused in performing a sleeve gastrectomy and/or a gastroplasty, asdescribed in U.S. application Ser. No. 12/242,765 entitled “SurgicalAccess Device” filed on Sep. 30, 2008; U.S. application Ser. No.12/242,711 entitled “Surgical Access Device with Protective Element”filed on Sep. 30, 2008; U.S. application Ser. No. 12/242,721 entitled“Multiple Port Surgical Access Device” filed on Sep. 30, 2008; U.S.application Ser. No. 12/242,726 entitled “Variable Surgical AccessDevice” filed on Sep. 30, 2008; U.S. application Ser. No. 12/242,333entitled “Methods and Devices for Performing Gastrectomies andGastroplasties” filed on Sep. 30, 2008; U.S. application Ser. No.12/242,353 entitled “Methods and Devices for Performing Gastrectomiesand Gastroplasties” filed on Sep. 30, 2008; and U.S. application Ser.No. 12/242,381 entitled “Methods and Devices for PerformingGastroplasties Using a Multiple Port Access Device” filed on Sep. 30,2008, all of which are hereby incorporated by reference in theirentireties.

The devices disclosed herein can be designed to be disposed of after asingle use, or they can be designed to be used multiple times. In eithercase, however, the device can be reconditioned for reuse after at leastone use. Reconditioning can include any combination of the steps ofdisassembly of the device, followed by cleaning or replacement ofparticular pieces, and subsequent reassembly. In particular, the devicecan be disassembled, and any number of the particular pieces or parts ofthe device can be selectively replaced or removed in any combination,e.g., a seal base, a housing, a proximal retractor base, etc. Uponcleaning and/or replacement of particular parts, the device can bereassembled for subsequent use either at a reconditioning facility, orby a surgical team immediately prior to a surgical procedure. Thoseskilled in the art will appreciate that reconditioning of a device canutilize a variety of techniques for disassembly, cleaning/replacement,and reassembly. Use of such techniques, and the resulting reconditioneddevice, are all within the scope of the present application.

Preferably, the invention described herein will be processed beforesurgery. First, a new or used instrument is obtained and if necessarycleaned. The instrument can then be sterilized. In one sterilizationtechnique, the instrument is placed in a closed and sealed container,such as a plastic or TYVEK bag. The container and instrument are thenplaced in a field of radiation that can penetrate the container, such asgamma radiation, x-rays, or high-energy electrons. The radiation killsbacteria on the instrument and in the container. The sterilizedinstrument can then be stored in the sterile container. The sealedcontainer keeps the instrument sterile until it is opened in the medicalfacility.

It is preferred that device is sterilized. This can be done by anynumber of ways known to those skilled in the art including beta or gammaradiation, ethylene oxide, steam, and a liquid bath (e.g., cold soak).

One skilled in the art will appreciate further features and advantagesof the invention based on the above-described embodiments. Accordingly,the invention is not to be limited by what has been particularly shownand described, except as indicated by the appended claims. Allpublications and references cited herein are expressly incorporatedherein by reference in their entirety.

What is claimed is:
 1. A surgical method, comprising: advancing a distalend of a first surgical instrument from outside a body of a patient suchthat the distal end of the first surgical instrument is located withinthe body of the patient, wherein an elongate shaft of the first surgicalinstrument is positioned in a single elongate tube that is positioned inan opening of the patient, and a seal is formed around the firstsurgical instrument in the elongate tube; advancing a distal end of asecond surgical instrument from outside the body of the patient suchthat the distal end of the second surgical instrument is located withinthe body of the patient, wherein an elongate shaft of the secondsurgical instrument is positioned in the elongate tube, and a seal isformed around the second surgical instrument in the elongate tube;advancing a distal end of an imaging device from outside the body of thepatient such that the distal end of the imaging device is located withinthe body of the patient, wherein an elongate shaft of the imaging deviceis positioned in the elongate tube, and a third seal is formed aroundthe imaging device in the elongate tube; with the distal ends of thefirst surgical instrument, second surgical instrument, and imagingdevice located within the body of the patient, rotating the first andsecond surgical instruments and the imaging device as a unit about alongitudinal axis of the elongate tube; with the distal ends of thefirst surgical instrument, second surgical instrument, and imagingdevice located within the body of the patient, moving the distal end ofthe first surgical instrument at an angle relative to the elongate tubeand the distal end of the second surgical instrument; and with thedistal ends of the first surgical instrument, second surgicalinstrument, and imaging device located within the body of the patient,moving the distal end of the second surgical instrument at an anglerelative to the elongate tube and the distal end of the first surgicalinstrument; wherein the opening is a natural orifice of the patient oris a minimally invasive incision formed in tissue of the patient.
 2. Themethod of claim 1, wherein a first sealing element forms the seal aroundthe first surgical instrument; a second sealing element forms the sealaround the second surgical instrument; a third sealing element forms theseal around the imaging device; and the first, second, and third sealingelements rotate with the imaging device and the first and secondsurgical elements about the longitudinal axis of the elongate tube. 3.The method of claim 2, further comprising, with the first seal formingthe seal around the first surgical instrument, rotating the firstsealing element relative to the second sealing element, the secondsurgical instrument, and the elongate tube, wherein the rotation of thefirst sealing element is about a first axis that is laterally offsetfrom the longitudinal axis of the elongate tube; and with the secondseal forming the seal around the second surgical instrument, rotatingthe second sealing element relative to the first sealing element, thefirst surgical instrument, and the elongate tube, wherein the rotationof the second sealing element is about a second axis that is laterallyoffset from the first axis and from the longitudinal axis of theelongate tube.
 4. The method of claim 2, wherein the rotation of thefirst sealing element is 360°, and the rotation of the second sealingelement is 360°.
 5. The method of claim 2, wherein the first, second,and third sealing elements are seated in a base, and the base alsorotates as a unit with the first and second surgical instruments.
 6. Themethod of claim 1, wherein the rotation is 360°.
 7. The method of claim1, further comprising releasably attaching the elongate tube to aproximal housing member; after the operative coupling of the elongatetube to the proximal housing member, positioning the elongate tube inthe opening, the proximal housing member being located entirely proximalto the opening; removing the elongate tube from the opening; and afterremoving the elongate tube from the opening, detaching the elongate tubefrom the proximal housing member.
 8. The method of claim 1, wherein eachof the first and second surgical instruments includes a grasper.
 9. Asurgical method, comprising: positioning a retractor within tissue of apatient to provide access through the tissue to a body cavity of thepatient; advancing a first surgical instrument through a first sealingelement disposed in a first opening formed in a base and then advancingthe first surgical instrument through a working channel extendingthrough the retractor, the first sealing element forming a seal aroundthe first surgical instrument; and advancing a second surgicalinstrument through a second sealing element disposed in a second openingformed in a sidewall of an intermediate base located between and coupledto the base and the retractor, the second sealing element forming a sealaround the second surgical instrument; wherein the first sealing elementhas a first longitudinal axis, the working channel has a secondlongitudinal axis that is substantially parallel to the firstlongitudinal axis, and the second sealing element has a thirdlongitudinal axis that is angularly offset from the first and secondlongitudinal axes.
 10. The method of claim 9, wherein the first surgicalinstrument extends through the first sealing element simultaneously withthe second surgical instrument extending through the second sealingelement.
 11. The method of claim 9, further comprising rotating the baserelative to the intermediate base with the first surgical instrumentextending through the first sealing element.
 12. The method of claim 9,further comprising rotating the first sealing element within the firstopening relative to the base and the intermediate base with the firstsurgical instrument extending through the first sealing element.
 13. Themethod of claim 9, further comprising advancing a third surgicalinstrument through a third sealing element disposed in a third openingformed in the base and then advancing the third surgical instrumentthrough the working channel extending through the retractor, the thirdsealing element forming a seal around the third surgical instrument;wherein the third opening has a fourth longitudinal axis that issubstantially parallel to the first and second longitudinal axes and isangularly offset from the third longitudinal axis.
 14. The method ofclaim 9, further comprising moving the second sealing element within thesecond opening so as to change the angular offset of the thirdlongitudinal axis relative to the first and second longitudinal axes.15. The method of claim 9, wherein the second sealing element is seatedat a fixed position in the second opening such that the angular offsetof the third longitudinal axis is fixed relative to the intermediatebase.
 16. A method of using a surgical device, comprising: mating aproximal housing to a distal retractor configured to provide a pathwaythrough tissue of a patient, thereby capturing a base between theproximal housing and the distal retractor; with the proximal housingmated to the distal retractor, rotating the base 360° about a centralpoint of the base relative to the proximal housing and the distalretractor; with the proximal housing mated to the distal retractor,rotating a first sealing element seated in a first opening in the base360° about a central point of the first opening relative to the proximalhousing, the distal retractor, and a second opening in the base having asecond sealing element seated therein, the first sealing element beingconfigured to form a seal around a first surgical instrument advancedtherethrough, and the second sealing element being configured to form aseal around a second surgical instrument advanced therethrough; with theproximal housing mated to the distal retractor, rotating the secondsealing element 360° about a central point of the second openingrelative to the proximal housing, the distal retractor, and the firstopening; and removing the proximal housing from the distal retractor,thereby releasing the base from between the proximal housing and thedistal retractor.
 17. The method of claim 16, further comprising, withthe proximal housing mated to the distal retractor, moving the firstsealing element laterally in a plane parallel to a plane defined by thebase, thereby changing a distance between the first sealing element andthe central point of the base.
 18. The method of claim 16, whereinmating the proximal housing to the distal retractor captures a springassembly between the base and the distal retractor, the spring assemblyforming a seal between the base and the distal retractor.
 19. The methodof claim 16, wherein the central point of the second sealing port islaterally offset from the central point of the base and is laterallyoffset from the central point of the first opening.
 20. The method ofclaim 16, further comprising positioning the distal retractor in thetissue of the patient.